Provider Information for 1912284860
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LATIA MONIQUE MAXWELL L.C.S.W.
Sex: Female
NPI: 1912284860
Last Updated: 2016-04-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1912284860 | ||||||||
| Enumeration Date | 2011-11-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3511 N 12TH AVE PENSACOLA, FL 32503-4010 United States Phone: 850-525-4545 | Fax: | ||||||||
| Primary Practice Address | 1201 W LAKEVIEW AVE PENSACOLA, FL 32501-1857 United States Phone: 850-469-3826 | Fax: | ||||||||
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