Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 0810002476 | VA |
Y | 103T00000X | Psychologist | 0810002476 | VA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810002476 | VA |
NPI | 1063606069 |
---|---|
Provider Name | Dr. Lisa Ann Teegarden-Cabay |
First Address | Salem, VA 24153-5165 |
Second Address | Salem, VA 24153-5165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2007 |
Last Update Date | 02/09/2007 |