Individual
SHANE GREGORY LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 CENTURY PARK S STE 102, BIRMINGHAM, AL 35226-3922
(888) 386-9624
Mailing address
335 ARABIAN RD, COLUMBIANA, AL 35051-3262
(815) 353-1013
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6552
WI
Other
Enumeration date
09/18/2017
Last updated
11/08/2022
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