Provider Demographics
NPI:1679654354
Name:BINGHAM, LOIS JANE (LPC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:JANE
Last Name:BINGHAM
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 1:1225 MARTHA CUSTIS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2000
Mailing Address - Country:US
Mailing Address - Phone:703-379-5055
Mailing Address - Fax:
Practice Address - Street 1:1225 MARTHA CUSTIS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2000
Practice Address - Country:US
Practice Address - Phone:703-379-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional