Individual
LATESAH ROSHA BURKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
105 EXECUTIVE DR, MADISON, MS 39110-8496
(601) 258-0818
Mailing address
205 TRAVIS CV, FLORA, MS 39071-8908
(601) 258-0818
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C11093
MS
Other
Enumeration date
06/22/2024
Last updated
06/22/2024
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