Healthcare Provider Details

I. General information

NPI: 1598370546
Provider Name (Legal Business Name): STEFANI C. LAIRD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W ELIZABETH ST STE 201
HARRISONBURG VA
22802-3811
US

IV. Provider business mailing address

136 W ELIZABETH ST STE 201
HARRISONBURG VA
22802-3811
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5104
  • Fax: 540-433-4053
Mailing address:
  • Phone: 540-564-5104
  • Fax: 540-433-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904011468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: