Healthcare Provider Details

I. General information

NPI: 1487940805
Provider Name (Legal Business Name): LISA FACINELLI LIC. AC., MAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 09/25/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 W BRADDOCK RD
ALEXANDRIA VA
22302-1900
US

IV. Provider business mailing address

2304 HIGGINS CIR
DOWNINGTOWN PA
19335-5010
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-1900
  • Fax:
Mailing address:
  • Phone: 610-888-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: