Fant, Deitra Latrice
Fant, Deitra Latrice is an sole proprietor health care provider with primary practice located at 137 National Plz Ste 300 , Oxon Hill MD 20745-1153. She recently has 8 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health, Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Community Health Worker, Agencies / Community/Behavioral Health, Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Fant, Deitra Latrice can be contacted via phone (703) 857-5354.Contact Information
Primary practice address
137 National Plz Ste 300
Oxon Hill MD 20745-1153
Phone: (703) 857-5354
Fax: (703) 857-5354
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 08861 | Louisiana |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | ||
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 0701009874 | Virginia |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | PRC15297 | District of Columbia |
| Other Service Providers / Case Manager/Care Coordinator | 171M00000X | ||
| Other Service Providers / Community Health Worker | 172V00000X | ||
| Agencies / Community/Behavioral Health | 251S00000X | ||
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X | ||
| Ambulatory Health Care Facilities / Adult Mental Health | 261QM0850X | ||
| Ambulatory Health Care Facilities / Adolescent and Children Mental Health | 261QM0855X | ||
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | LC10267 | Maryland |
Profile Details
| NPI number | 1699131896 |
|---|---|
| LBN Legal business name | Fant, Deitra Latrice |
| Credentials | MA,NCC,LCPC,LPC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 5th, 2016 |
| Last updated | Feb 16th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699131896 | NPPES |
| Maryland | MEDICAID | 566703141985 | |
| Maryland | MEDICAID | 566703141985 | |
| Maryland | MEDICAID | 20731 |
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