Healthcare Provider Details

I. General information

NPI: 1790295343
Provider Name (Legal Business Name): SHANA ULON LATHAM LPC PRC13693
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 LENFANT SQ SE
WASHINGTON DC
20020-6724
US

IV. Provider business mailing address

3321 7TH ST SE
WASHINGTON DC
20032-4212
US

V. Phone/Fax

Practice location:
  • Phone: 202-584-1244
  • Fax: 202-584-1249
Mailing address:
  • Phone: 202-373-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPRC13693
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPRC13693
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPRC13693
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: