Healthcare Provider Details

I. General information

NPI: 1902002678
Provider Name (Legal Business Name): JEANINE SONGY LATHAM RD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 BROCKENBRAUGH CT
METAIRIE LA
70005-2712
US

IV. Provider business mailing address

654 BROCKENBRAUGH CT
METAIRIE LA
70005-2712
US

V. Phone/Fax

Practice location:
  • Phone: 504-919-0134
  • Fax:
Mailing address:
  • Phone: 504-919-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6833
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number526
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: