Provider Demographics
NPI:1134691900
Name:BROUGHTON, LA'KISHA (LPC)
Entity Type:Individual
Prefix:
First Name:LA'KISHA
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LA'KISHA
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:224 SILVER FOX TRCE
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3349
Mailing Address - Country:US
Mailing Address - Phone:757-214-2372
Mailing Address - Fax:
Practice Address - Street 1:13195 WARWICK BLVD STE 2E
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8313
Practice Address - Country:US
Practice Address - Phone:757-214-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty