Individual
MS. FONDA GAIL LATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1305 S BAXTER AVE, TYLER, TX 75701-3404
(903) 714-1130
Mailing address
113 HENRY DR, BULLARD, TX 75757-9375
(903) 714-1130
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00557
TX
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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