Provider Demographics
NPI:1740714427
Name:WILLIAMS, LATISHA DENISE (CHES)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 SPRINGBANK LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3378
Mailing Address - Country:US
Mailing Address - Phone:704-774-3044
Mailing Address - Fax:704-774-3045
Practice Address - Street 1:3125 SPRINGBANK LN
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3378
Practice Address - Country:US
Practice Address - Phone:704-774-3044
Practice Address - Fax:704-774-3045
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator