Provider Demographics
NPI:1790295343
Name:LATHAM, SHANA ULON (LPC PRC13693)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ULON
Last Name:LATHAM
Suffix:
Gender:F
Credentials:LPC PRC13693
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4212
Mailing Address - Country:US
Mailing Address - Phone:202-373-1302
Mailing Address - Fax:
Practice Address - Street 1:1301 LENFANT SQ SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6724
Practice Address - Country:US
Practice Address - Phone:202-584-1244
Practice Address - Fax:202-584-1249
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13693101YS0200X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty