Provider Demographics
NPI:1306721675
Name:HARVISON, LATOSHA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:LATOSHA
Middle Name:MARIE
Last Name:HARVISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 CALI CV
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9552
Mailing Address - Country:US
Mailing Address - Phone:731-394-0986
Mailing Address - Fax:
Practice Address - Street 1:3420 OLD GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3634
Practice Address - Country:US
Practice Address - Phone:901-222-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN160161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical