Healthcare Provider Details

I. General information

NPI: 1366357543
Provider Name (Legal Business Name): LORI COLLIER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 SEMINOLE TRL STE 104
CHARLOTTESVILLE VA
22901-1160
US

IV. Provider business mailing address

1885 SEMINOLE TRL STE 104
CHARLOTTESVILLE VA
22901-1160
US

V. Phone/Fax

Practice location:
  • Phone: 434-218-5446
  • Fax: 434-218-5446
Mailing address:
  • Phone: 434-218-5446
  • Fax: 434-218-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: