Provider Demographics
NPI:1033090402
Name:NATHAN, LETETHIA
Entity type:Individual
Prefix:
First Name:LETETHIA
Middle Name:
Last Name:NATHAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 TOWNE CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4451
Mailing Address - Country:US
Mailing Address - Phone:443-313-3240
Mailing Address - Fax:301-329-2025
Practice Address - Street 1:626 TOWNE CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4451
Practice Address - Country:US
Practice Address - Phone:443-313-3240
Practice Address - Fax:301-329-2025
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical