Provider Demographics
NPI:1891813820
Name:LEE-LATISAW, CANDI L (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:L
Last Name:LEE-LATISAW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:CANDI
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:122 WHITMOOR TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1519
Mailing Address - Country:US
Mailing Address - Phone:301-613-6092
Mailing Address - Fax:301-576-3823
Practice Address - Street 1:1338 FARRAGUT STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:301-613-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3002291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical