Provider Demographics
NPI:1659904373
Name:LAIRD, KAIMARE (LPC, CMPC)
Entity Type:Individual
Prefix:
First Name:KAIMARE
Middle Name:
Last Name:LAIRD
Suffix:
Gender:M
Credentials:LPC, CMPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WHITWORTH WAY APT 203
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3677
Mailing Address - Country:US
Mailing Address - Phone:312-351-5982
Mailing Address - Fax:
Practice Address - Street 1:5700 WARHILL TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-9419
Practice Address - Country:US
Practice Address - Phone:757-253-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty