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Individual

LATASHA MATTHEWS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1840 OLD NORCROSS RD STE 300, LAWRENCEVILLE, GA 30044-8803
(404) 914-2521
Mailing address
392 CLEARSPRINGS DR, LAWRENCEVILLE, GA 30046-6881

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
006599
GA
101YP2500X
Professional Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003121649B
GA
Enumeration date
12/08/2011
Last updated
07/26/2017
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