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General NPI Number Information
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NPI Number | 1508010232
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Entity Type | Organization
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Legal Business Name | L R MINOR LLC
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 910 PRINCESS ANNE ST SUITE 109
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5844
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Country | US
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Telephone | 540-656-2106
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Fax | 540-656-2107
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Provider Business Mailing Address
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Address Line | 910 PRINCESS ANNE ST SUITE 109
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5844
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Country | US
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Telephone | 540-656-2106
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Fax | 540-656-2107
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LINDA R MINOR
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Credential | LCSW
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Telephone | 540-361-4330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0904002023
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License Number State | VA
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