1053313031 NPI number — SANDRA GILBERT-LANE LPC

Table of content: SANDRA GILBERT-LANE LPC (NPI 1053313031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053313031 NPI number — SANDRA GILBERT-LANE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERT-LANE
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053313031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1417 N BATTLEFIELD BLVD.
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-4579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-436-0605
Provider Business Mailing Address Fax Number:
757-436-0023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1417 BATTLEFIELD BLVD N # 4579
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-436-0605
Provider Business Practice Location Address Fax Number:
757-436-0023
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0701002051 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 053027 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 233450 . This is a "MAMSI/MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A000414 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 227940000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 229303 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5403944 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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