Provider Demographics
NPI:1255680658
Name:HARVEY, LETTICIA (MSW)
Entity Type:Individual
Prefix:
First Name:LETTICIA
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OTTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SOPCHOPPY
Mailing Address - State:FL
Mailing Address - Zip Code:32358-1026
Mailing Address - Country:US
Mailing Address - Phone:850-321-1666
Mailing Address - Fax:
Practice Address - Street 1:2711 W. 15TH STREET
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1366
Practice Address - Country:US
Practice Address - Phone:850-769-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical