Provider Demographics
NPI:1053313031
Name:GILBERT-LANE, SANDRA (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GILBERT-LANE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 N BATTLEFIELD BLVD.
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4579
Mailing Address - Country:US
Mailing Address - Phone:757-436-0605
Mailing Address - Fax:757-436-0023
Practice Address - Street 1:1417 BATTLEFIELD BLVD N # 4579
Practice Address - Street 2:SUITE 260
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4516
Practice Address - Country:US
Practice Address - Phone:757-436-0605
Practice Address - Fax:757-436-0023
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA053027OtherBLUECROSS/BLUESHIELD
233450OtherMAMSI/MDIPA
A000414OtherVALUE OPTIONS
227940000OtherMAGELLAN
229303OtherCOMPSYCH
VA5403944Medicaid