Healthcare Provider Details

I. General information

NPI: 1184310765
Provider Name (Legal Business Name): LOIS WALTERS-THREAT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7760 SHRADER RD STE B
HENRICO VA
23228-2552
US

IV. Provider business mailing address

7330 STAPLES MILL RD # 285
RICHMOND VA
23228-4122
US

V. Phone/Fax

Practice location:
  • Phone: 804-591-0002
  • Fax: 833-449-5204
Mailing address:
  • Phone: 804-724-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024186903
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: