Healthcare Provider Details

I. General information

NPI: 1477037935
Provider Name (Legal Business Name): LAURAN GLOVER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW STE 200
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

5902 MOUNT EAGLE DR APT 605
ALEXANDRIA VA
22303-2517
US

V. Phone/Fax

Practice location:
  • Phone: 614-406-9464
  • Fax:
Mailing address:
  • Phone: 614-406-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY200001597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: