Provider Demographics
NPI:1346613023
Name:LATITUDE HEALTH SERVICES.COM
Entity Type:Organization
Organization Name:LATITUDE HEALTH SERVICES.COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-487-9033
Mailing Address - Street 1:412 H ST NE
Mailing Address - Street 2:NE SUITE100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4336
Mailing Address - Country:US
Mailing Address - Phone:240-487-9033
Mailing Address - Fax:
Practice Address - Street 1:412 H ST NE
Practice Address - Street 2:NE SUITE100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4336
Practice Address - Country:US
Practice Address - Phone:240-487-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health