Provider Demographics
NPI:1073564134
Name:LANIER, VICKI MOOZA (LPC)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:MOOZA
Last Name:LANIER
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 1:10400 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3705
Mailing Address - Country:US
Mailing Address - Phone:757-596-7938
Mailing Address - Fax:757-596-7939
Practice Address - Street 1:10400 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3705
Practice Address - Country:US
Practice Address - Phone:757-596-7938
Practice Address - Fax:757-596-7939
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010227917OtherVA PREMIER
VA010227917Medicaid
VA7528472OtherAETNA
VA3109874OtherMAMSI
VA34318OtherTRICARE PRIME &STANDARD
VAA998366OtherVALUE OPTIONS
VA184465OtherANTHEM
VA088950MOtherSENTARA
VA491593000OtherMAGELLAN