Provider Demographics
NPI:1073844858
Name:WASHINGTON, LATIKA NICOLE (CSAC, ICS, LPC-IT)
Entity Type:Individual
Prefix:MISS
First Name:LATIKA
Middle Name:NICOLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CSAC, ICS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2420
Mailing Address - Country:US
Mailing Address - Phone:414-698-1150
Mailing Address - Fax:
Practice Address - Street 1:2436 N 50TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2814
Practice Address - Country:US
Practice Address - Phone:414-445-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1606-226101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1073844858Medicaid