Provider Demographics
NPI:1437409448
Name:RADDLER, LATRINA R (MED, LPC-S)
Entity type:Individual
Prefix:MRS
First Name:LATRINA
Middle Name:R
Last Name:RADDLER
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S FOSTER DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5943
Mailing Address - Country:US
Mailing Address - Phone:225-389-6110
Mailing Address - Fax:
Practice Address - Street 1:17023 AVOCET DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4739
Practice Address - Country:US
Practice Address - Phone:225-421-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4510101YM0800X
WAMHC.LH.61597761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health