Provider Demographics
NPI:1326385576
Name:COUSAR, KHALIAH JANELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KHALIAH
Middle Name:JANELLE
Last Name:COUSAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 3RD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-4746
Mailing Address - Country:US
Mailing Address - Phone:540-416-0413
Mailing Address - Fax:
Practice Address - Street 1:107 3RD AVE STE A
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-4746
Practice Address - Country:US
Practice Address - Phone:540-416-0413
Practice Address - Fax:855-728-5253
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007581101YP2500X
PA292651101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor