Provider Demographics
NPI:1235787805
Name:WINSTON, LATASHA DENISE
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:DENISE
Last Name:WINSTON
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 1:3608 W FRANKLIN BLVD APT 2B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-1218
Mailing Address - Country:US
Mailing Address - Phone:312-810-8145
Mailing Address - Fax:
Practice Address - Street 1:3608 W FRANKLIN BLVD APT 2B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-1218
Practice Address - Country:US
Practice Address - Phone:312-810-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty