Individual
MRS. LACONDA GERTRUDE FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY,D, LPC
Contact information
Practice address
600 MEDICAL DR, SUITE A & B, HAMPTON, VA 23666-1769
(757) 788-0600
Mailing address
300 MEDICAL DR, 2ND FLOOR, HAMPTON, VA 23666-1765
(757) 788-0300
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003750
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010117241
—
VA
05
—
4945573
—
VA
Enumeration date
09/14/2006
Last updated
02/04/2009
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