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General NPI Number Information
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NPI Number | 1881405769
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Entity Type | Individual
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Provider Name | LATRESHIA LILLY
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Gender | Female
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Dates
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Enumeration Date | 01/18/2025
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 3109 N FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17110-1310
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Country | US
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Telephone | 717-256-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 1062 SUPERIOR DR APT D
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City | HARRISBURG
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State | PA
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Zip | 17111-8072
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Country | US
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Telephone | 985-635-9533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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