Provider Demographics
NPI:1952518318
Name:LOTT, VIRGINIA A (MFT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:LOTT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-973 WIKAO ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3966
Mailing Address - Country:US
Mailing Address - Phone:808-627-0608
Mailing Address - Fax:
Practice Address - Street 1:95-973 WIKAO ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3966
Practice Address - Country:US
Practice Address - Phone:808-627-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist