Provider Demographics
NPI:1437237831
Name:LEAK, LATASHA TAMEKIA (FAMILY ADVOCATE)
Entity Type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:TAMEKIA
Last Name:LEAK
Suffix:
Gender:F
Credentials:FAMILY ADVOCATE
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:LEAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:114 N WASHINGTON ST
Practice Address - Street 2:STE 30
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R968OtherCAREFIRST FEDERAL GROUP
MDLM49EAOtherCAREFIRST BCBS GROUP
517251OtherUHC MAMSI GROUP#
MD742LMedicare ID - Type Unspecified