Provider Demographics
NPI:1477022689
Name:FORD, LATRECIA LATICE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:LATRECIA
Middle Name:LATICE
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WHITNEY GRN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1682
Mailing Address - Country:US
Mailing Address - Phone:210-781-5831
Mailing Address - Fax:
Practice Address - Street 1:4211 WHITNEY GREEN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-7824
Practice Address - Country:US
Practice Address - Phone:210-781-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional