Provider Demographics
NPI:1396381455
Name:URSIN, LATASHA QUENSHAY
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:QUENSHAY
Last Name:URSIN
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 1:23 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3219
Mailing Address - Country:US
Mailing Address - Phone:321-314-2892
Mailing Address - Fax:
Practice Address - Street 1:1277 N SEMORAN BLVD STE 117
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3574
Practice Address - Country:US
Practice Address - Phone:800-921-0442
Practice Address - Fax:877-725-4150
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW422563101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor