Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 5632 | SC |
NPI | 1003166265 |
---|---|
Provider Name | Hannah Latta |
First Address | Lexington, SC 29072-2670 |
Second Address | Lexington, SC 29072-2371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2012 |
Last Update Date | 07/02/2019 |