Provider Demographics
NPI:1568930188
Name:WHITE, LATASHA MARIE (LCSW,TCADC)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW,TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 RUSSELL LEE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-4304
Mailing Address - Country:US
Mailing Address - Phone:502-876-1445
Mailing Address - Fax:
Practice Address - Street 1:1949 GOLDSMITH LN STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3096
Practice Address - Country:US
Practice Address - Phone:502-509-7207
Practice Address - Fax:502-785-4003
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2539481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical