Provider Demographics
NPI:1649508979
Name:COTTON, LATASHA MONIQUE (HHA/CNA/ PHLEBOTOMY)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:MONIQUE
Last Name:COTTON
Suffix:
Gender:F
Credentials:HHA/CNA/ PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 KIMI GRAY CT SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5917
Mailing Address - Country:US
Mailing Address - Phone:202-907-5424
Mailing Address - Fax:202-907-5424
Practice Address - Street 1:82 ALLISON ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6736
Practice Address - Country:US
Practice Address - Phone:202-399-0552
Practice Address - Fax:202-399-0552
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TR0400X
DCHHA4861374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$Medicaid