Individual
MRS. DEITRA LATRICE FANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,NCC,LCPC,LPC
Contact information
Practice address
120 WATERFRONT ST STE 420, OXON HILL, MD 20745-1122
(703) 857-5354
(571) 601-4607
Mailing address
120 WATERFRONT ST STE 420, OXON HILL, MD 20745-1122
(703) 857-5354
(571) 601-4607
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC10267
MD
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
0701009874
VA
101YP2500X
Professional Counselor
08861
LA
101YP2500X
Professional Counselor
Primary
LC10267
MD
101YP2500X
Professional Counselor
PRC15297
DC
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20731
—
MD
05
—
566703141985
—
DC
05
—
566703141985
—
MD
Enumeration date
01/05/2016
Last updated
12/29/2025
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