Provider Demographics
NPI:1750079539
Name:BARHAM, TAESHAWN LAVAR
Entity type:Individual
Prefix:
First Name:TAESHAWN
Middle Name:LAVAR
Last Name:BARHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 KING ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3019
Mailing Address - Country:US
Mailing Address - Phone:757-895-9503
Mailing Address - Fax:
Practice Address - Street 1:2009 KING ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3019
Practice Address - Country:US
Practice Address - Phone:757-895-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service