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NPI Code Detail

MEDICARE: SHANA ULON LATHAM LPC PRC13693

MEDICARE: SHANA ULON LATHAM LPC PRC13693
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YS0200XSchool CounselorPRC13693DC
2101YA0400XAddiction (Substance Use Disorder) CounselorPRC13693DC
3101Y00000XCounselorPRC13693DC

General Provider Information

NPI Number : 1790295343
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANA ULON LATHAM LPC PRC13693
Provider Business Mailing Address
First Line : 3321 7TH ST SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-4212
Country : US
Telephone Number : 202-373-1302
Fax Number :
Provider Business Practice Location Address
First Line : 1301 LENFANT SQ SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6724
Country : US
Telephone Number : 202-584-1244
Fax Number : 202-584-1249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2017
Last Update Date : 10/10/2017

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