Provider Demographics
NPI:1841886405
Name:HATCHER, LATRICE DENISE
Entity type:Individual
Prefix:
First Name:LATRICE
Middle Name:DENISE
Last Name:HATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LATRICE
Other - Middle Name:DENISE
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LATRICE DENISE PEAY
Mailing Address - Street 1:PO BOX 189262
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-9262
Mailing Address - Country:US
Mailing Address - Phone:916-826-1300
Mailing Address - Fax:
Practice Address - Street 1:5053 JURGENSON WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-2502
Practice Address - Country:US
Practice Address - Phone:916-826-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0700X, 171M00000X, 171W00000X, 1744R1103X
CAD2174896172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder