Provider Demographics
NPI:1750839429
Name:GOLDSON, LATHIEMA (DMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:LATHIEMA
Middle Name:
Last Name:GOLDSON
Suffix:
Gender:F
Credentials:DMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10796 PINES BLVD
Mailing Address - Street 2:101
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3919
Mailing Address - Country:US
Mailing Address - Phone:954-367-4888
Mailing Address - Fax:
Practice Address - Street 1:10796 PINES BLVD
Practice Address - Street 2:101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3919
Practice Address - Country:US
Practice Address - Phone:954-367-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist