Provider Demographics
NPI:1548935943
Name:DUMAS, LATANYA HULEEN (CRADC)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:HULEEN
Last Name:DUMAS
Suffix:
Gender:F
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7943 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2170
Mailing Address - Country:US
Mailing Address - Phone:816-678-9457
Mailing Address - Fax:
Practice Address - Street 1:7943 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2170
Practice Address - Country:US
Practice Address - Phone:816-678-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)