Provider Demographics
NPI:1487086765
Name:RICHARDSON, LATANYA S (MSED, LMHC)
Entity type:Individual
Prefix:MRS
First Name:LATANYA
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 E COUNTY LINE RD UNIT 435
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3439
Mailing Address - Country:US
Mailing Address - Phone:813-330-0423
Mailing Address - Fax:
Practice Address - Street 1:2902 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1828
Practice Address - Country:US
Practice Address - Phone:813-330-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health