Provider Demographics
NPI:1174367908
Name:BROWN, LATESKA TYNESHA (MSW)
Entity type:Individual
Prefix:
First Name:LATESKA
Middle Name:TYNESHA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7936
Mailing Address - Country:US
Mailing Address - Phone:256-542-0022
Mailing Address - Fax:
Practice Address - Street 1:450 DUNLOP BLVD SW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35857
Practice Address - Country:US
Practice Address - Phone:256-541-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker