Provider Demographics
NPI:1467684258
Name:ROBINSON, LATISHA T (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:T
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LATISHA
Other - Middle Name:T
Other - Last Name:PENNYWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, GSW
Mailing Address - Street 1:510 E STONER AVE
Mailing Address - Street 2:SOCIAL WORK SERVICE
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4243
Mailing Address - Country:US
Mailing Address - Phone:318-990-5074
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:SOCIAL WORK SERVICE
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-990-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8348104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker