Provider Demographics
NPI:1245666288
Name:JOSIE, CHARESE LAKISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHARESE
Middle Name:LAKISA
Last Name:JOSIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3508
Mailing Address - Country:US
Mailing Address - Phone:757-613-8801
Mailing Address - Fax:
Practice Address - Street 1:500 WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3508
Practice Address - Country:US
Practice Address - Phone:757-613-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2019-07-08
Deactivation Date:2014-04-21
Deactivation Code:
Reactivation Date:2019-03-20
Provider Licenses
StateLicense IDTaxonomies
VA0904006053104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker