Individual
LATASHA ABRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4210 COLUMBIA RD, SUITE 5D, MARTINEZ, GA 30907-0401
(706) 836-3193
Mailing address
4210 COLUMBIA RD, SUITE 5D, MARTINEZ, GA 30907-0401
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC009282
GA
101YM0800X
Mental Health Counselor
LPC009282
GA
101YP2500X
Professional Counselor
Primary
LPC009282
GA
Other
Enumeration date
08/29/2016
Last updated
03/04/2019
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