Provider Demographics
NPI:1386781219
Name:LATORRE, CAROL ANN (LICSW CDP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:LATORRE
Suffix:
Gender:F
Credentials:LICSW CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GEO WA WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-946-8490
Mailing Address - Fax:509-946-8519
Practice Address - Street 1:750 GEO WA WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-946-8490
Practice Address - Fax:509-946-8519
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001046101YA0400X
WALW000053051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical