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Provider Information for 1427205152


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Ms. TARA SUZETTE HAZZARD-PATTERSON LPC


Sex: Female

NPI: 1427205152
Last Updated: 2008-09-09
Certification Date:

Details

NameValue
NPI1427205152
Enumeration Date2008-08-25
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 300 MEDICAL DR
HAMPTON, VA 23666-1765
United States

Phone: 757-788-0300 | Fax:
 
Primary Practice Address 600 MEDICAL DR
HAMPTON NEWPORT NEWS COMMUNITY SERVICES BOARD
HAMPTON, VA 23666-6079
United States

Phone: 757-788-0500 | Fax:757-788-0928
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)1427205151NPI
MEDICAIDVA49-45573
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthVA0701004293