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General NPI Number Information
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NPI Number | 1104438969
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Entity Type | Organization
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Legal Business Name | LANTERN PATH THERAPY, PLLC
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 4732 LONGHILL RD STE 3202
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1586
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Country | US
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Telephone | 540-226-5534
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Fax | 757-852-0473
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Provider Business Mailing Address
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Address Line | 1464 YAKIMA RD
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City | QUINTON
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State | VA
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Zip | 23141-1935
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | VICTORIA HAYNES
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Credential | LPC, LMFT
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Telephone | 540-226-5534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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