Basic Information
| Provider Information | |||||||||
| NPI: | 1316661671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS-ELLIOTT | ||||||||
| FirstName: | LATRELL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LGPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 ROSEMONT AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216132131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677300360 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 403 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432255780 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2022 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LGP13104 | MD | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.