Provider Demographics
NPI:1154983419
Name:SEALS, LETISHA L (LCSW)
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:L
Last Name:SEALS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 SHARP LN APT 228
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-1450
Mailing Address - Country:US
Mailing Address - Phone:225-249-9370
Mailing Address - Fax:
Practice Address - Street 1:567 SHARP LN APT 228
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-1450
Practice Address - Country:US
Practice Address - Phone:225-249-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA107951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical