Provider Demographics
NPI:1164912820
Name:MAHGOUB, LANA ADIL (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:ADIL
Last Name:MAHGOUB
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 AMERICAN LEGION RD STE 23
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5655
Mailing Address - Country:US
Mailing Address - Phone:757-483-2580
Mailing Address - Fax:
Practice Address - Street 1:3101 AMERICAN LEGION RD STE 23
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5655
Practice Address - Country:US
Practice Address - Phone:757-448-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11460101Y00000X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101Y00000XBehavioral Health & Social Service ProvidersCounselor