Healthcare Provider Details

I. General information

NPI: 1538727672
Provider Name (Legal Business Name): LATISHIA SANCHEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 07/23/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80A VETERANS BLVD
ACOMA NM
87034
US

IV. Provider business mailing address

PO BOX 1018
LAGUNA NM
87026-1018
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-7292
  • Fax:
Mailing address:
  • Phone: 505-449-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0689
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-10728
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: