Healthcare Provider Details

I. General information

NPI: 1104127687
Provider Name (Legal Business Name): LEA SPENCER TRANT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 EXECUTIVE DR SUITE C
HAMPTON VA
23666-6604
US

IV. Provider business mailing address

512 GERREY DR
CHESAPEAKE VA
23323-3221
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7707
  • Fax:
Mailing address:
  • Phone: 757-390-6201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: