Provider Demographics
NPI:1417597311
Name:LAHENDRO, ELIZABETH DYE (LPC, PSC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DYE
Last Name:LAHENDRO
Suffix:
Gender:F
Credentials:LPC, PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 MCGILL ST
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1930
Mailing Address - Country:US
Mailing Address - Phone:804-833-4789
Mailing Address - Fax:
Practice Address - Street 1:2727 ENTERPRISE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-6341
Practice Address - Country:US
Practice Address - Phone:804-261-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty