Provider Demographics
NPI:1235509332
Name:LIGGINS, TAKARA
Entity Type:Individual
Prefix:
First Name:TAKARA
Middle Name:
Last Name:LIGGINS
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-0399
Mailing Address - Country:US
Mailing Address - Phone:804-397-2067
Mailing Address - Fax:
Practice Address - Street 1:4000 AIRLINE DR STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:804-397-2067
Practice Address - Fax:804-397-2067
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health