Healthcare Provider Details

I. General information

NPI: 1942291182
Provider Name (Legal Business Name): LATAYA ELAINE DUREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATAYA ELAINE HAWKINS LCSW, BCD

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD DEPT OF BEHAVORIAL HEALTH, DEWITT ARMY HOSPITAL
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

17306 BROOKHOLLOW GROVE CT
HOUSTON TX
77084-6046
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0110
  • Fax:
Mailing address:
  • Phone: 713-775-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: