Provider Demographics
NPI:1538700562
Name:LATHAM, SARAH RUTH (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RUTH
Last Name:LATHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRICKERTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-3608
Mailing Address - Country:US
Mailing Address - Phone:662-570-1109
Mailing Address - Fax:
Practice Address - Street 1:102 BRICKERTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-3608
Practice Address - Country:US
Practice Address - Phone:626-570-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5540C1041C0700X
MSC108871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical