Healthcare Provider Details

I. General information

NPI: 1679953079
Provider Name (Legal Business Name): PATRICIA LATIMER LPCC, LCDC III, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

IV. Provider business mailing address

284 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-5309
  • Fax: 330-743-2756
Mailing address:
  • Phone: 330-743-5309
  • Fax: 330-743-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number141298
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1300340
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 1302965
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: