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NPI Code Detail

MEDICARE: TRAKETA LA'SHAWN DILLARD LPC

MEDICARE: TRAKETA LA'SHAWN DILLARD 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
1101YP2500XProfessional Counselor0701009985VA

General Provider Information

NPI Number : 1952902595
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAKETA LA'SHAWN DILLARD LPC
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number : 540-224-5352
Fax Number :
Provider Business Practice Location Address
First Line : 3005 PETERS CREEK RD NW
Second Line :
City : ROANOKE
State : VA
Zip : 24019-2738
Country : US
Telephone Number : 540-251-7728
Fax Number : 540-434-2127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2020
Last Update Date : 04/28/2025

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