Provider Demographics
NPI:1962748798
Name:SMITH, LATASHA (LCSW)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N MILL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1274
Mailing Address - Country:US
Mailing Address - Phone:630-608-9010
Mailing Address - Fax:
Practice Address - Street 1:1801 N MILL ST
Practice Address - Street 2:SUITE D
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1274
Practice Address - Country:US
Practice Address - Phone:630-608-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490151231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical