Provider Demographics
NPI:1477962314
Name:LATHAM, AMBER MANIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MANIS
Last Name:LATHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CITICO ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5811
Mailing Address - Country:US
Mailing Address - Phone:865-522-0661
Mailing Address - Fax:865-522-3670
Practice Address - Street 1:412 CITICO ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5811
Practice Address - Country:US
Practice Address - Phone:865-522-0661
Practice Address - Fax:865-522-3670
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional