Provider Demographics
NPI:1609122969
Name:FORD, KATERESEA LASHA (LPC)
Entity Type:Individual
Prefix:
First Name:KATERESEA
Middle Name:LASHA
Last Name:FORD
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 1:2423 LAMB AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4419
Mailing Address - Country:US
Mailing Address - Phone:804-525-4101
Mailing Address - Fax:804-525-4102
Practice Address - Street 1:2423 LAMB AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-4419
Practice Address - Country:US
Practice Address - Phone:804-525-4101
Practice Address - Fax:804-525-4102
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional