Provider Demographics
NPI:1669059432
Name:WARREN-LILLY, VONDA LATOYISHA (LPC)
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:LATOYISHA
Last Name:WARREN-LILLY
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 1:4425 PORTSMOUTH BLVD STE 210E
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2152
Mailing Address - Country:US
Mailing Address - Phone:757-822-9139
Mailing Address - Fax:
Practice Address - Street 1:4425 PORTSMOUTH BLVD STE 210E
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2152
Practice Address - Country:US
Practice Address - Phone:757-822-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07010010339101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701010339OtherLICENSE