=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619274214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL LELAND LASHLEY PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2011
-----------------------------------------------------
Last Update Date | 10/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1655 FORT MYER DRIVE SUITE 350
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-362-7416
-----------------------------------------------------
Fax | 703-391-1031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1655 FORT MYER DRIVE SUITE 350
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-362-7416
-----------------------------------------------------
Fax | 703-391-1031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0810002910
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------