Provider Demographics
NPI:1801360185
Name:GOLDEN, LATASHA LYNN
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:LYNN
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3630
Mailing Address - Country:US
Mailing Address - Phone:734-883-4136
Mailing Address - Fax:
Practice Address - Street 1:1558 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3630
Practice Address - Country:US
Practice Address - Phone:734-883-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician