Individual
MASHEIL RENAY LATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
48 MADISON AVE, LINDENWOLD, NJ 08021-1621
(856) 343-9429
Mailing address
48 MADISON AVE, LINDENWOLD, NJ 08021-1621
(856) 343-9429
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
990367213
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
990367213
NJ
104100000X
Social Worker
990367213
NJ
Other
Enumeration date
06/29/2011
Last updated
05/06/2014
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