Healthcare Provider Details

I. General information

NPI: 1891446084
Provider Name (Legal Business Name): LAURA KANGELARIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11357 NUCKOLS RD # 1186
GLEN ALLEN VA
23059-5504
US

IV. Provider business mailing address

11357 NUCKOLS RD # 1186
GLEN ALLEN VA
23059-5504
US

V. Phone/Fax

Practice location:
  • Phone: 804-655-0677
  • Fax:
Mailing address:
  • Phone: 804-655-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0730000438
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM18519
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: