Provider Demographics
NPI:1487712832
Name:PRATHER, LATALIA (LMSW)
Entity type:Individual
Prefix:
First Name:LATALIA
Middle Name:
Last Name:PRATHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 TOWNE CENTER PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4870
Mailing Address - Country:US
Mailing Address - Phone:601-952-0894
Mailing Address - Fax:601-952-0836
Practice Address - Street 1:357 TOWNE CENTER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4870
Practice Address - Country:US
Practice Address - Phone:601-952-0894
Practice Address - Fax:601-952-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1958-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker