Provider Demographics
NPI:1821456690
Name:LATIMER, ROSITA ANN (CADC II, QMHA-R)
Entity Type:Individual
Prefix:
First Name:ROSITA
Middle Name:ANN
Last Name:LATIMER
Suffix:
Gender:F
Credentials:CADC II, QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:541-684-4148
Mailing Address - Fax:541-762-0606
Practice Address - Street 1:1651 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3363
Practice Address - Country:US
Practice Address - Phone:541-762-4525
Practice Address - Fax:541-726-2467
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health