Provider Demographics
NPI:1619636966
Name:SPENCE, LATRINA (BS, MHP)
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:BS, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:IL
Mailing Address - Zip Code:62914-1810
Mailing Address - Country:US
Mailing Address - Phone:618-734-2665
Mailing Address - Fax:618-734-1999
Practice Address - Street 1:1401 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:IL
Practice Address - Zip Code:62914-1810
Practice Address - Country:US
Practice Address - Phone:618-734-2665
Practice Address - Fax:618-734-1999
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health