Provider Demographics
NPI:1023402518
Name:RAND, LETITIA (SACIT)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:
Last Name:RAND
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 W WELLS ST
Mailing Address - Street 2:APT 115
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-4806
Mailing Address - Country:US
Mailing Address - Phone:414-554-2573
Mailing Address - Fax:
Practice Address - Street 1:3118 W WELLS ST
Practice Address - Street 2:APT 115
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-4806
Practice Address - Country:US
Practice Address - Phone:414-554-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)