Individual
LATEYA SPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
12007 SUNRISE VALLEY DR STE 120, RESTON, VA 20191-3460
(508) 663-3852
Mailing address
12007 SUNRISE VALLEY DR STE 120, RESTON, VA 20191-3460
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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