Fanning, Laconda Gertrude
Fanning, Laconda Gertrude is an individual health care provider with primary practice located at 600 Medical Dr Suite A & B, Hampton VA 23666-1769. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Fanning, Laconda Gertrude can be contacted via phone (757) 788-0600.Contact Information
Primary practice address
600 Medical Dr Suite A & B
Hampton VA 23666-1769
Phone: (757) 788-0600
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 0701003750 | Virginia |
Profile Details
| NPI number | 1700981396 |
|---|---|
| LBN Legal business name | Fanning, Laconda Gertrude |
| Credentials | PSY,D, LPC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 14th, 2006 |
| Last updated | Feb 4th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700981396 | NPPES |
| Virginia | MEDICAID | 010117241 | |
| Virginia | MEDICAID | 4945573 |
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