Healthcare Provider Details

I. General information

NPI: 1043174642
Provider Name (Legal Business Name): MRS. LISA NICOLE SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 5TH ST
RICHMOND VA
23219-3825
US

IV. Provider business mailing address

4700 LAKEFIELD MEWS PL APT E
HENRICO VA
23231-4163
US

V. Phone/Fax

Practice location:
  • Phone: 804-819-4000
  • Fax: 804-819-5221
Mailing address:
  • Phone: 804-819-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: