Healthcare Provider Details

I. General information

NPI: 1699605329
Provider Name (Legal Business Name): LALANAI C GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ELDEN ST STE 302
HERNDON VA
20170-4851
US

IV. Provider business mailing address

13900 HEDGEWOOD DR APT 403
WOODBRIDGE VA
22193-5982
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-4371
  • Fax:
Mailing address:
  • Phone: 240-606-7339
  • Fax: 240-606-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-535559
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: