Individual
MISS LATASHIA N PETTIFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAC-AD
Contact information
Practice address
6207 BELAIR RD, BALTIMORE, MD 21206-1942
(443) 835-2681
Mailing address
6900 EASTBROOK AVE, BALTIMORE, MD 21224-1839
(443) 226-0310
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2967
MD
Other
Enumeration date
07/02/2021
Last updated
07/02/2021
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