MEDICARE: MRS. LATASHA ADGERSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701013337	VA

General Provider Information

NPI Number	:	1376278051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATASHA ADGERSON LPC

Provider Business Mailing Address
First Line	:	1111 HOKE LN
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-2637
Country	:	US
Telephone Number	:	703-209-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 CRAWFORD ST STE 333
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2819
Country	:	US
Telephone Number	:	757-383-9215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	02/29/2024

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