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Individual

LATASHA SPRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PRSS

Contact information

Practice address
1109 JEFFERSON RD STE C, SOUTH CHARLESTON, WV 25309-8815
(877) 338-2725
(304) 715-3537
Mailing address
1109 JEFFERSON RD STE C, SOUTH CHARLESTON, WV 25309-8815
(187) 733-8272

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1356980916
MEDICAID NPI
WV
05
1356980916
WV
Enumeration date
01/14/2022
Last updated
01/31/2023
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