Individual
DEBRA D LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3471 KNICKERBOCKER RD, STE 508, SAN ANGELO, TX 76904-8826
(325) 942-7531
(325) 942-7532
Mailing address
2942 SIERRA CIR, SAN ANGELO, TX 76904-7016
(325) 949-0646
(325) 942-7532
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S06774
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117983
SUPERIOR HEALTHPLAN
TX
01
—
125054
MHN/HMC CLAIMS
TX
Enumeration date
06/24/2005
Last updated
07/26/2007
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