Provider Demographics
NPI:1851179337
Name:KNIGHT, DECCA TALIAFERRO (LPC)
Entity type:Individual
Prefix:
First Name:DECCA
Middle Name:TALIAFERRO
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9540 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BENT MOUNTAIN
Mailing Address - State:VA
Mailing Address - Zip Code:24059-2012
Mailing Address - Country:US
Mailing Address - Phone:540-204-2070
Mailing Address - Fax:
Practice Address - Street 1:360 CAMPBELL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3625
Practice Address - Country:US
Practice Address - Phone:540-563-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional