Provider Demographics
NPI:1245013184
Name:MOORE, LATISHA (LPC, CSAC)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:LATISHA
Other - Middle Name:
Other - Last Name:DIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC,CSAC
Mailing Address - Street 1:154 NEWTOWN RD STE B-2
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2412
Mailing Address - Country:US
Mailing Address - Phone:757-777-4956
Mailing Address - Fax:
Practice Address - Street 1:154 NEWTOWN RD STE B-2
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2412
Practice Address - Country:US
Practice Address - Phone:757-777-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)