Provider Demographics
NPI:1447936687
Name:GIVENS, LANETTE REGINA (MS)
Entity type:Individual
Prefix:MISS
First Name:LANETTE
Middle Name:REGINA
Last Name:GIVENS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:LANETTE
Other - Middle Name:REGINA
Other - Last Name:GIVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:6121 HOT SPRING LANE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:804-732-5698
Mailing Address - Fax:
Practice Address - Street 1:240
Practice Address - Street 2:EXECUTIVE CENTER PARKWAY
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:180-473-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733007019101Y00000X
VA0732005003101YM0800X
VAPGP-0687265221700000X
VA0710103711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist