Provider Demographics
NPI:1285606566
Name:LATSKO, TIMOTHY WILLIAM (LMFT, LPC, DOT-SAP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:LATSKO
Suffix:
Gender:M
Credentials:LMFT, LPC, DOT-SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JIB CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5281
Mailing Address - Country:US
Mailing Address - Phone:757-208-0950
Mailing Address - Fax:757-208-0950
Practice Address - Street 1:101 JIB CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5281
Practice Address - Country:US
Practice Address - Phone:757-208-0950
Practice Address - Fax:757-208-0950
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003702101YM0800X
SC3786101YM0800X
VA0717001186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285606566Medicaid