Individual
LATAVIA JO NEKOL HARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 GRAHAM RD, FLORISSANT, MO 63031-8077
(314) 308-9807
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
178.018456
IL
Other
Enumeration date
01/03/2022
Last updated
03/12/2024
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