=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518593524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN L NOST LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2020
-----------------------------------------------------
Last Update Date | 03/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1525 HUGUENOT RD
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-2438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 482-085-2804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6008 BONNEAU RD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23227-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-761-1101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904009708
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------