Provider Demographics
NPI:1902035884
Name:LATHAM-SHIFLETT, CAROLYN ELIZABETH (DBH, LCSW, CGCS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:LATHAM-SHIFLETT
Suffix:
Gender:F
Credentials:DBH, LCSW, CGCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EATON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4095
Mailing Address - Country:US
Mailing Address - Phone:757-964-7827
Mailing Address - Fax:757-964-7466
Practice Address - Street 1:2 EATON ST STE 300
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4095
Practice Address - Country:US
Practice Address - Phone:757-964-7827
Practice Address - Fax:757-964-7466
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical