Healthcare Provider Details

I. General information

NPI: 1982892113
Provider Name (Legal Business Name): STEPHANIE JILL LACROIX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N 25TH ST BASEMENT
RICHMOND VA
23223-6539
US

IV. Provider business mailing address

719 N 25TH ST BASEMENT
RICHMOND VA
23223-6539
US

V. Phone/Fax

Practice location:
  • Phone: 804-643-0002
  • Fax: 804-643-3106
Mailing address:
  • Phone: 804-643-0002
  • Fax: 804-643-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: