Provider Demographics
NPI:1750405676
Name:SINSABAUGH, LARRY LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:SINSABAUGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:LEE
Other - Last Name:SINSABAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:4801 HERMITAGE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3332
Mailing Address - Country:US
Mailing Address - Phone:804-262-0571
Mailing Address - Fax:804-262-5937
Practice Address - Street 1:4801 HERMITAGE RD
Practice Address - Street 2:SUITE 20
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3332
Practice Address - Country:US
Practice Address - Phone:804-262-0571
Practice Address - Fax:804-262-5937
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717-000060106H00000X
VA0715-000035171M00000X
VA09-574058251S00000X
NC2104101YP2500X
WV1377101YP2500X
MD001735101Y00000X
VA0701-00000036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor