Provider Demographics
NPI:1134765613
Name:LATIMER, ELISHA M (LPC)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:M
Last Name:LATIMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3851
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-3851
Mailing Address - Country:US
Mailing Address - Phone:864-392-4966
Mailing Address - Fax:864-835-8851
Practice Address - Street 1:1214 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4729
Practice Address - Country:US
Practice Address - Phone:864-392-4966
Practice Address - Fax:864-835-8851
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional