Provider Demographics
NPI:1700566809
Name:GIVENS, LAQUESHA
Entity Type:Individual
Prefix:MS
First Name:LAQUESHA
Middle Name:
Last Name:GIVENS
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 1:14336 LOCO SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:23882-3562
Mailing Address - Country:US
Mailing Address - Phone:804-943-6226
Mailing Address - Fax:
Practice Address - Street 1:14336 LOCO SCHOOL RD
Practice Address - Street 2:
Practice Address - City:STONY CREEK
Practice Address - State:VA
Practice Address - Zip Code:23882-3562
Practice Address - Country:US
Practice Address - Phone:804-943-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator