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General NPI Number Information
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NPI Number | 1902035884
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Entity Type | Individual
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Provider Name | CAROLYN ELIZABETH LATHAM-SHIFLETT DBH, LCSW, CGCS
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Gender | Female
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 729 THIMBLE SHOALS BLVD STE 5A
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4217
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Country | US
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Telephone | 757-964-7774
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Fax | 757-257-0023
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Provider Business Mailing Address
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Address Line | 6651 EVERETS RD
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City | SUFFOLK
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State | VA
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Zip | 23434-6980
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Country | US
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Telephone | 757-964-7774
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Fax | 757-257-0022
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007051
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License Number State | VA
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