Provider Demographics
NPI:1669150108
Name:LIGGONS, KIARA
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:LIGGONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 BOGEY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7416
Mailing Address - Country:US
Mailing Address - Phone:804-298-0986
Mailing Address - Fax:
Practice Address - Street 1:5103 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-6003
Practice Address - Country:US
Practice Address - Phone:804-298-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health