Provider Demographics
NPI:1043615297
Name:GASKINS, LAQUITA
Entity Type:Individual
Prefix:
First Name:LAQUITA
Middle Name:
Last Name:GASKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAQUITA
Other - Middle Name:YULETTE
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:217 LASSITER CT
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-9283
Mailing Address - Country:US
Mailing Address - Phone:270-300-1841
Mailing Address - Fax:
Practice Address - Street 1:217 LASSITER CT
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-9283
Practice Address - Country:US
Practice Address - Phone:270-300-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1754OtherKENTUCKY LICENSE CERTIFICATE