Healthcare Provider Details

I. General information

NPI: 1669215448
Provider Name (Legal Business Name): LAURIE I TAMS GENETIC COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W BROAD ST STE 100
RICHMOND VA
23230-1709
US

IV. Provider business mailing address

7130 GLEN FOREST DR STE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-4084
  • Fax:
Mailing address:
  • Phone: 804-662-6138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0139000036
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: