Individual
LATISHA MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 INDIANOLA AVE, COLUMBUS, OH 43201-2118
(614) 294-2661
Mailing address
1515 INDIANOLA AVE, COLUMBUS, OH 43201-2118
(614) 294-2661
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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