Healthcare Provider Details

I. General information

NPI: 1285606566
Provider Name (Legal Business Name): TIMOTHY WILLIAM LATSKO LMFT, LPC, DOT-SAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JIB CT
WILLIAMSBURG VA
23185-5281
US

IV. Provider business mailing address

101 JIB CT
WILLIAMSBURG VA
23185-5281
US

V. Phone/Fax

Practice location:
  • Phone: 757-208-0950
  • Fax: 757-208-0950
Mailing address:
  • Phone: 757-208-0950
  • Fax: 757-208-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701003702
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3786
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001186
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: