Provider Demographics
NPI:1144951047
Name:SUMMERS, LATISHA M (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:M
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:MS
Other - First Name:LATISHA
Other - Middle Name:M
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIR LOSS SPECIALIST
Mailing Address - Street 1:1831 TRYON DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6214
Mailing Address - Country:US
Mailing Address - Phone:910-882-1579
Mailing Address - Fax:
Practice Address - Street 1:4808 RAMSEY ST STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1671
Practice Address - Country:US
Practice Address - Phone:910-882-1579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management