Healthcare Provider Details

I. General information

NPI: 1083325997
Provider Name (Legal Business Name): ANTHONY G LADIKOS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 DISCOVERY PARK BLVD STE 201
WILLIAMSBURG VA
23188-2860
US

IV. Provider business mailing address

5360 DISCOVERY PARK BLVD STE 201
WILLIAMSBURG VA
23188-2860
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015494
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: