Healthcare Provider Details

I. General information

NPI: 1548155195
Provider Name (Legal Business Name): LATASHIA M MCLEOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11828 FISHING POINT DR STE 102
NEWPORT NEWS VA
23606-4500
US

IV. Provider business mailing address

90 PARK DR
PALMYRA VA
22963-3255
US

V. Phone/Fax

Practice location:
  • Phone: 757-746-2332
  • Fax:
Mailing address:
  • Phone: 919-480-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018367
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: