Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 0810001904 | VA |
N | 103TC0700X | Clinical Psychologist | 0810001904 | VA |
N | 103TA0700X | Adult Development & Aging Psychologist | 0810001904 | VA |
N | 103TR0400X | Rehabilitation Psychologist | 0810001904 | VA |
NPI | 1265403877 |
---|---|
Provider Name | Lola Byrd |
First Address | Roanoke, VA 24018-3547 |
Second Address | Roanoke, VA 24018-3547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R60384 | (02) |