Provider Demographics
NPI:1225114549
Name:FLY, FRANCIS LANIER (DMIN)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:LANIER
Last Name:FLY
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 J CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1540
Mailing Address - Country:US
Mailing Address - Phone:757-873-8566
Mailing Address - Fax:757-873-8566
Practice Address - Street 1:718 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1540
Practice Address - Country:US
Practice Address - Phone:757-873-8566
Practice Address - Fax:757-873-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0717000127OtherLMFT
11239871OtherUNIVERSAL CREDENTIALLING