Provider Demographics
NPI:1982045829
Name:NAZWORTH, LISA P (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:P
Last Name:NAZWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 WESTERRE PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1328
Mailing Address - Country:US
Mailing Address - Phone:804-221-5646
Mailing Address - Fax:804-360-7063
Practice Address - Street 1:3781 WESTERRE PKWY STE F
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1328
Practice Address - Country:US
Practice Address - Phone:804-221-5646
Practice Address - Fax:804-360-7063
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040087351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$Medicaid