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:
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Health care specialties

SpecialtyCodeLicense #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 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700981396 NPPES
Virginia MEDICAID 010117241
Virginia MEDICAID 4945573

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