Healthcare Provider Details

I. General information

NPI: 1124843289
Provider Name (Legal Business Name): LATIFAH WHITFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 CLEARFIELD AVE STE 401
VIRGINIA BEACH VA
23462-1816
US

IV. Provider business mailing address

601 HILLPOINT BLVD APT 716
SUFFOLK VA
23434-8194
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax:
Mailing address:
  • Phone: 757-309-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014101
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: