Provider Demographics
NPI:1285108100
Name:WOOLCOCK, LATASHA TINIA
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:TINIA
Last Name:WOOLCOCK
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 1:1316 SOMERVILLE RD SE STE 1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4309
Mailing Address - Country:US
Mailing Address - Phone:205-260-7361
Mailing Address - Fax:256-355-6092
Practice Address - Street 1:1315 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4308
Practice Address - Country:US
Practice Address - Phone:256-260-7306
Practice Address - Fax:256-355-6092
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health