Provider Information for 1649338823
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Ms. AUDRA ELISABETH LATHAM LMHC
Sex: Female
NPI: 1649338823
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1649338823 | ||||||||
| Enumeration Date | 2006-12-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9536 PRINCETON SQUARE BLVD S APT 2507 JACKSONVILLE, FL 32256-8357 United States Phone: 904-234-4660 | Fax: | ||||||||
| Primary Practice Address | 10250 NORMANDY BLVD UNIT 802 JACKSONVILLE, FL 32221-8064 United States Phone: 904-379-7155 | Fax:904-379-7165 | ||||||||
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