1699190363 NPI number — TRINITA RENEE LATTIMORE LCPC-S

Table of content: TRINITA RENEE LATTIMORE LCPC-S (NPI 1699190363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699190363 NPI number — TRINITA RENEE LATTIMORE LCPC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LATTIMORE
Provider First Name:
TRINITA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LATTIMORE
Provider Other First Name:
TRINITA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC-S
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699190363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12138 CENTRAL AVE APT 575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-648-2335
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9135 PISCATAWAY RD., 3RD FL., STE 340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-648-2335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LC8509 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)