Healthcare Provider Details

I. General information

NPI: 1043615297
Provider Name (Legal Business Name): LAQUITA GASKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAQUITA YULETTE GASKINS LPCA

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 LASSITER CT
RADCLIFF KY
40160-9283
US

IV. Provider business mailing address

217 LASSITER CT
RADCLIFF KY
40160-9283
US

V. Phone/Fax

Practice location:
  • Phone: 270-300-1841
  • Fax:
Mailing address:
  • Phone: 270-300-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1754
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: