Provider Demographics
NPI:1033720412
Name:LATTIMORE, SHAKILA B (MA,BSW, ADC, AADC-IP)
Entity Type:Individual
Prefix:
First Name:SHAKILA
Middle Name:B
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:MA,BSW, ADC, AADC-IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307
Mailing Address - Country:US
Mailing Address - Phone:864-582-7588
Mailing Address - Fax:864-487-2764
Practice Address - Street 1:129 DILLON DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2930
Practice Address - Country:US
Practice Address - Phone:864-582-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)