Individual
LATAYVIA RENEE SHADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QBA
Contact information
Practice address
4288 CARTEGENA WAY, LAS VEGAS, NV 89121-6504
(615) 347-3115
Mailing address
4288 CARTEGENA WAY, LAS VEGAS, NV 89121-6504
(615) 347-3115
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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