Provider Demographics
NPI:1992514533
Name:NORMAN, JACQUELINE LATASHA (LPC-R)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LATASHA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8712 PROCTORS RUN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2757
Mailing Address - Country:US
Mailing Address - Phone:804-301-1129
Mailing Address - Fax:
Practice Address - Street 1:8712 PROCTORS RUN DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-2757
Practice Address - Country:US
Practice Address - Phone:804-301-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704008654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional