Provider Demographics
NPI:1164265856
Name:DOXEN, LATASHA
Entity type:Individual
Prefix:MS
First Name:LATASHA
Middle Name:
Last Name:DOXEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 ADAM CLAYTON POWELL JR BLVD APT 40
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1829
Mailing Address - Country:US
Mailing Address - Phone:347-397-9759
Mailing Address - Fax:
Practice Address - Street 1:2400 ADAM CLAYTON POWELL JR BLVD APT 40
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1829
Practice Address - Country:US
Practice Address - Phone:347-397-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health