Provider Demographics
NPI:1770129892
Name:ELLIOTT, LATEISHA (DBH, MS, LPC, CRC)
Entity type:Individual
Prefix:DR
First Name:LATEISHA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DBH, MS, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHASE LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-8139
Mailing Address - Country:US
Mailing Address - Phone:256-658-9123
Mailing Address - Fax:
Practice Address - Street 1:509 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4206
Practice Address - Country:US
Practice Address - Phone:256-658-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AL4064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)