Provider Demographics
NPI:1427205152
Name:HAZZARD-PATTERSON, TARA SUZETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:SUZETTE
Last Name:HAZZARD-PATTERSON
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 1:300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1765
Mailing Address - Country:US
Mailing Address - Phone:757-788-0300
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL DR
Practice Address - Street 2:HAMPTON NEWPORT NEWS COMMUNITY SERVICES BOARD
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6079
Practice Address - Country:US
Practice Address - Phone:757-788-0500
Practice Address - Fax:757-788-0928
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427205151OtherNPI
VA49-45573Medicaid
VA49-45573Medicaid