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Individual
MS. VIRGINIA TAVERNER
Active
Individual
MS. VIRGINIA TAVERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000988
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008023170
—
CT
05
—
008024427
—
CT
05
—
008039745
—
CT
01
—
008045348
TAVERNER MEDICAID
—
Enumeration date
06/10/2013
Last updated
10/02/2017
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