Provider Demographics
NPI:1972287308
Name:TAVARES, JAHAIRA (LCSW)
Entity type:Individual
Prefix:
First Name:JAHAIRA
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 OLMSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1431
Mailing Address - Country:US
Mailing Address - Phone:347-295-4972
Mailing Address - Fax:
Practice Address - Street 1:1120 LASKIN RD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5273
Practice Address - Country:US
Practice Address - Phone:757-650-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0835881041C0700X
VA09040148301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical