Provider Demographics
NPI:1295181873
Name:KENDRICK, LATASHA (ME)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 COCOPLUM CIR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5934
Mailing Address - Country:US
Mailing Address - Phone:954-536-1456
Mailing Address - Fax:
Practice Address - Street 1:3701 COCOPLUM CIR
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-5934
Practice Address - Country:US
Practice Address - Phone:954-536-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL886298101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool