Provider Demographics
NPI:1093915803
Name:MATTHEWS, LATASHA D
Entity Type:Individual
Prefix:MISS
First Name:LATASHA
Middle Name:D
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SYCAMORE VIEW RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7658
Mailing Address - Country:US
Mailing Address - Phone:901-503-3474
Mailing Address - Fax:
Practice Address - Street 1:1200 SYCAMORE VIEW RD STE 206
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7658
Practice Address - Country:US
Practice Address - Phone:901-503-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker