Provider Demographics
NPI:1578575585
Name:TAYLOR, LAVERNE WASHINGTON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:WASHINGTON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 CUTSHAW AVE
Mailing Address - Street 2:303
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-5024
Mailing Address - Country:US
Mailing Address - Phone:804-353-3324
Mailing Address - Fax:804-353-4498
Practice Address - Street 1:3212 CUTSHAW AVE
Practice Address - Street 2:303
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-5024
Practice Address - Country:US
Practice Address - Phone:804-353-3324
Practice Address - Fax:804-353-4498
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05436P37Medicare ID - Type Unspecified