Healthcare Provider Details

I. General information

NPI: 1265403877
Provider Name (Legal Business Name): LOLA BYRD PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 ELECTRIC RD SUITE 100
ROANOKE VA
24018-3547
US

IV. Provider business mailing address

2727 ELECTRIC RD SUITE 100
ROANOKE VA
24018-3547
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-5153
  • Fax: 540-772-5157
Mailing address:
  • Phone: 540-772-5153
  • Fax: 540-772-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810001904
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number0810001904
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number0810001904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: