Gardner, Latasha
Gardner, Latasha is an individual health care provider with primary practice located at 816 Broad St Suite 23, Meriden CT 06450-4350. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Gardner, Latasha can be contacted via phone (203) 630-2499.Contact Information
Primary practice address
816 Broad St Suite 23
Meriden CT 06450-4350
Phone: (203) 630-2499
Fax: (203) 630-2499
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2820 | Connecticut |
Profile Details
| NPI number | 1235584095 |
|---|---|
| LBN Legal business name | Gardner, Latasha |
| Credentials | Licensed Professional Counselor (LPC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 29th, 2016 |
| Last updated | Apr 29th, 2016 - about 8 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 | 1235584095 | NPPES |
| Connecticut | MEDICAID | 008062953 |
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