Provider Demographics
NPI:1346731288
Name:LATIMORE, AMBER (LGPC CAS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LATIMORE
Suffix:
Gender:F
Credentials:LGPC CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 STOCKTON LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-0074
Mailing Address - Country:US
Mailing Address - Phone:954-892-9968
Mailing Address - Fax:
Practice Address - Street 1:3830 STOCKTON LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0074
Practice Address - Country:US
Practice Address - Phone:954-892-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional