Provider Demographics
NPI:1528942653
Name:POLEGA, LATASHA (LMHP-R)
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:
Last Name:POLEGA
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5443 BOAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-4518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5443 BOAR SWAMP RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-4518
Practice Address - Country:US
Practice Address - Phone:757-332-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health