Individual
LATISHA ROSE MUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PEER RECOVERY COACH
Contact information
Practice address
620 N AURORA ST, STOCKTON, CA 95202-2343
(209) 468-8786
(209) 468-9611
Mailing address
620 N AURORA ST, STOCKTON, CA 95202-2343
(209) 468-8786
(209) 468-9611
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/15/2018
Last updated
10/30/2023
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