Healthcare Provider Details

I. General information

NPI: 1538528146
Provider Name (Legal Business Name): ANNETTE LUMSDEN-COOK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E GERMAN SCHOOL RD
RICHMOND VA
23224-1460
US

IV. Provider business mailing address

249 E GERMAN SCHOOL RD
RICHMOND VA
23224-1460
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-4751
  • Fax: 804-592-4752
Mailing address:
  • Phone: 804-592-4751
  • Fax: 804-592-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008588
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0904008588
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: