Provider Demographics
NPI:1790113470
Name:TARLTON, TAKIYA (LPC)
Entity Type:Individual
Prefix:MISS
First Name:TAKIYA
Middle Name:
Last Name:TARLTON
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 1:3810 INDIAN RIVER RD.
Mailing Address - Street 2:#13074
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-1831
Mailing Address - Country:US
Mailing Address - Phone:757-450-5873
Mailing Address - Fax:
Practice Address - Street 1:3810 INDIAN RIVER RD.
Practice Address - Street 2:#13074
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-1831
Practice Address - Country:US
Practice Address - Phone:757-450-5873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional