Healthcare Provider Details

I. General information

NPI: 1386767374
Provider Name (Legal Business Name): LISA LASHUK PSY.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 KING ST STE 330
ALEXANDRIA VA
22314-2760
US

IV. Provider business mailing address

1737 KING ST STE 330
ALEXANDRIA VA
22314-2760
US

V. Phone/Fax

Practice location:
  • Phone: 919-636-0087
  • Fax:
Mailing address:
  • Phone: 919-636-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810006295
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: