Provider Demographics
NPI:1912616731
Name:MORTON-WARREN, LATASHIA
Entity Type:Individual
Prefix:
First Name:LATASHIA
Middle Name:
Last Name:MORTON-WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12774 WISTERIA DR UNIT 1001
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20875-7554
Mailing Address - Country:US
Mailing Address - Phone:240-200-4068
Mailing Address - Fax:
Practice Address - Street 1:12774 WISTERIA DR UNIT 1001
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20875-7554
Practice Address - Country:US
Practice Address - Phone:240-200-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09040126311041C0700X
DCLC500822261041C0700X
MD198801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical