Healthcare Provider Details

I. General information

NPI: 1225114549
Provider Name (Legal Business Name): FRANCIS LANIER FLY D.MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1540
US

IV. Provider business mailing address

718 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1540
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-8566
  • Fax: 757-873-8566
Mailing address:
  • Phone: 757-873-8566
  • Fax: 757-873-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: