Provider Demographics
NPI:1679314629
Name:LANDIS, LINDSAY (EDS)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:LANDIS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 TAMARACK TRL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2629
Mailing Address - Country:US
Mailing Address - Phone:540-556-0155
Mailing Address - Fax:
Practice Address - Street 1:2922 TAMARACK TRL
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2629
Practice Address - Country:US
Practice Address - Phone:540-556-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool