Provider Demographics
NPI:1508404963
Name:TAYLOR PARKER, LATEEFAH FAHEEMAH (CSAC)
Entity type:Individual
Prefix:
First Name:LATEEFAH
Middle Name:FAHEEMAH
Last Name:TAYLOR PARKER
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 GILLIS RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-3120
Mailing Address - Country:US
Mailing Address - Phone:757-644-2804
Mailing Address - Fax:757-765-7073
Practice Address - Street 1:100 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4800
Practice Address - Country:US
Practice Address - Phone:757-606-9421
Practice Address - Fax:757-765-7073
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103981101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)