Provider Information for 1295307312
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ANGELA LYNNE LEGRANDE LPC, CPSC
Sex: Female
NPI: 1295307312
Last Updated: 2021-07-16
Certification Date: 2021-07-16
Certification Date: 2021-07-16
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1295307312 | ||||||||||||
| Enumeration Date | 2021-07-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4209 EAGLE DR HOPEWELL, VA 23860-1770 United States Phone: 804-433-8632 | Fax: | ||||||||||||
| Primary Practice Address | 20 W BANK ST PETERSBURG, VA 23803-3279 United States Phone: 804-862-8002 | Fax:804-294-2545 | ||||||||||||
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