Provider Demographics
NPI:1801279781
Name:THOMAS, LATANIA (LISW-S)
Entity type:Individual
Prefix:MS
First Name:LATANIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 S DIXIE HWY 162
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005
Mailing Address - Country:US
Mailing Address - Phone:513-678-7827
Mailing Address - Fax:513-217-1215
Practice Address - Street 1:3481 S DIXIE HWY 162
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005
Practice Address - Country:US
Practice Address - Phone:513-678-7827
Practice Address - Fax:513-217-1215
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14404131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical