Provider Demographics
NPI:1437584273
Name:BOONE, LATAUSHA JEANELL (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:LATAUSHA
Middle Name:JEANELL
Last Name:BOONE
Suffix:
Gender:F
Credentials:LPC, NCC
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 38936
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1311
Mailing Address - Country:US
Mailing Address - Phone:804-439-7578
Mailing Address - Fax:804-302-7976
Practice Address - Street 1:2025 E MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7069
Practice Address - Country:US
Practice Address - Phone:804-439-7578
Practice Address - Fax:804-302-7976
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006267101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health