Provider Demographics
NPI:1225765985
Name:CRISP, NAKISHA LATARRA
Entity Type:Individual
Prefix:
First Name:NAKISHA
Middle Name:LATARRA
Last Name:CRISP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ROANOKE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2512
Mailing Address - Country:US
Mailing Address - Phone:540-322-3040
Mailing Address - Fax:
Practice Address - Street 1:2100 ROANOKE ST STE 1
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2512
Practice Address - Country:US
Practice Address - Phone:540-322-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)