Provider Demographics
NPI:1134630346
Name:CHISHOLM, LATISHA (LICSW)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 DEXTER TER SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5203
Mailing Address - Country:US
Mailing Address - Phone:240-903-0470
Mailing Address - Fax:
Practice Address - Street 1:1345 DEXTER TER SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5203
Practice Address - Country:US
Practice Address - Phone:240-903-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500811341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical