Provider Demographics
NPI:1760361489
Name:LATSON, ANTOINETTE (LCSW)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:LATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 N PAULINO HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:TALOFOFO
Mailing Address - State:GU
Mailing Address - Zip Code:96915-3737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:246 N PAULINO HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:TALOFOFO
Practice Address - State:GU
Practice Address - Zip Code:96915-3737
Practice Address - Country:US
Practice Address - Phone:671-486-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULCSW-E-0211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical