Provider Demographics
NPI:1891410478
Name:CHAVEZ, TAISHA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:TAISHA
Middle Name:MARIE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAISHA
Other - Middle Name:MARIE
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:85 NEWBURY DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4620
Mailing Address - Country:US
Mailing Address - Phone:540-273-3943
Mailing Address - Fax:
Practice Address - Street 1:306 WESTWOOD OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5108
Practice Address - Country:US
Practice Address - Phone:540-699-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health