Healthcare Provider Details

I. General information

NPI: 1235854480
Provider Name (Legal Business Name): NICOLE LOREN LEFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19420 GOLF VISTA PLZ STE 250
LANSDOWNE VA
20176-8267
US

IV. Provider business mailing address

43167 ALLENBY WAY
LEESBURG VA
20176-6474
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 571-598-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704012969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: