Provider Demographics
NPI:1801950621
Name:HERRICK, LISA RACHEL (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RACHEL
Last Name:HERRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HERRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7700 LEESBURG PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2615
Mailing Address - Country:US
Mailing Address - Phone:703-847-5793
Mailing Address - Fax:703-847-5791
Practice Address - Street 1:7700 LEESBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2615
Practice Address - Country:US
Practice Address - Phone:703-847-5793
Practice Address - Fax:703-847-5791
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0107001816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist