Individual
LATISHA LOUISE FONTANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED. L.P.C.
Contact information
Practice address
2646 HIGHWAY 109, SUITE 200, GROVER, MO 63040-1162
(636) 458-0002
(636) 458-0002
Mailing address
2646 HIGHWAY 109, SUITE 200, GROVER, MO 63040-1162
(636) 458-0002
(636) 458-0002
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CS001907
MO
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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