Provider Demographics
NPI:1093444598
Name:EDMERSON, LATESHA SABREE (LGPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:LATESHA
Middle Name:SABREE
Last Name:EDMERSON
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 RODGERS FORGE RD APT TA
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-5302
Mailing Address - Country:US
Mailing Address - Phone:973-699-5233
Mailing Address - Fax:
Practice Address - Street 1:2300 GARRISON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2308
Practice Address - Country:US
Practice Address - Phone:410-233-6200
Practice Address - Fax:410-233-6201
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional