Provider Demographics
NPI:1336200542
Name:LUSBYDENHAM, ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:LUSBYDENHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4031
Mailing Address - Country:US
Mailing Address - Phone:540-774-4686
Mailing Address - Fax:540-989-8893
Practice Address - Street 1:3635 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4031
Practice Address - Country:US
Practice Address - Phone:540-774-4686
Practice Address - Fax:540-989-8893
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7775545Medicare UPIN
VA829948W01Medicare ID - Type Unspecified
VA624026Medicare UPIN
VAM-5040001Medicare UPIN
VA112519Medicare UPIN