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 1:21525 RIDGETOP CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6510
Mailing Address - Country:US
Mailing Address - Phone:703-662-1719
Mailing Address - Fax:
Practice Address - Street 1:21525 RIDGETOP CIR STE 110
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-6510
Practice Address - Country:US
Practice Address - Phone:703-662-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11460101Y00000X
103TC2200X
VA0810006314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent