Provider Demographics
NPI:1285607457
Name:LANAHAN, TERESA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:LANAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 2ND ST SW
Mailing Address - Street 2:STE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4944
Mailing Address - Country:US
Mailing Address - Phone:540-344-4600
Mailing Address - Fax:540-344-0793
Practice Address - Street 1:1026 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4402
Practice Address - Country:US
Practice Address - Phone:540-344-4600
Practice Address - Fax:540-344-0793
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA008951195Medicaid
VAVA008951195Medicaid