Provider Demographics
NPI:1003681461
Name:LAYNE, CALVIN III (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:LAYNE
Suffix:III
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 EATON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2221
Mailing Address - Country:US
Mailing Address - Phone:571-463-8620
Mailing Address - Fax:571-999-7549
Practice Address - Street 1:10304 EATON PL STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2221
Practice Address - Country:US
Practice Address - Phone:571-463-8620
Practice Address - Fax:571-999-7549
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188311363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health