Provider Demographics
NPI:1336601236
Name:LATIMORE, ERRON DAJUAN SR (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ERRON
Middle Name:DAJUAN
Last Name:LATIMORE
Suffix:SR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E AMBOISE CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1357
Mailing Address - Country:US
Mailing Address - Phone:301-801-7006
Mailing Address - Fax:
Practice Address - Street 1:142 E AMBOISE CT
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1357
Practice Address - Country:US
Practice Address - Phone:301-801-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health