Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YS0200X | School Counselor | 429007 | GA |
N | 225C00000X | Rehabilitation Counselor | GA | |
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1386936631 |
---|---|
Provider Name | Ms. Latasha Dudley |
First Address | Lagrange, GA 30241-1879 |
Second Address | Douglasville, GA 30135-8469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 21/10/2019 |