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Individual

DANIEL LATHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC/MHSP

Contact information

Practice address
1203 PLANTATION DR, JOHNSON CITY, TN 37604-6311
(276) 791-4721
Mailing address
1203 PLANTATION DR, JOHNSON CITY, TN 37604-6311
(276) 791-4721

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4421
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NA
NA
Enumeration date
09/16/2020
Last updated
12/16/2020
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