Doctor Name: | MASHEIL RENAY LATHAM |
NPI Number: | 1356638340 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 990367213 |
Business Practice Address: | 48 Madison Ave Lindenwold, NJ - 080211621 |
Business Phone Number: | 8563439429 |
Business Fax Number: | |
Mailing Address: | 48 Madison Ave, LINDENWOLD |
State: | NJ |
Postal Code: | 080211621 |
Phone Number: | 8563439429 |
Fax Number: | |
NPI Enumeration Date: | 06/29/2011 |
NPI Last Update Date: | 05/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 990367213 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |