Provider Demographics
NPI:1134178627
Name:RANNIGAN, ROBERT C (LPC MED)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:RANNIGAN
Suffix:
Gender:M
Credentials:LPC MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SACHEM PLACE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-978-1773
Mailing Address - Fax:434-978-4049
Practice Address - Street 1:1441 SACHEM PLACE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-978-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001063101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA002806OtherANTHEM
VA38497OtherOPTIMA