Provider Demographics
NPI:1457118598
Name:BALL, LATISHA SHUNA (LMFT)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:SHUNA
Last Name:BALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHUNA
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:4211 CARTULINA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2701
Mailing Address - Country:US
Mailing Address - Phone:858-761-2741
Mailing Address - Fax:
Practice Address - Street 1:333 NUTMEG ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6212
Practice Address - Country:US
Practice Address - Phone:619-271-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist