Provider Demographics
NPI:1871202549
Name:DAILEY, LATISHA SHARNICE
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:SHARNICE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATISHA
Other - Middle Name:SHARNICE
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR LATISHA DAILEY LL
Mailing Address - Street 1:150 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-1818
Mailing Address - Country:US
Mailing Address - Phone:251-359-6459
Mailing Address - Fax:
Practice Address - Street 1:150 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-1818
Practice Address - Country:US
Practice Address - Phone:251-359-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRES011238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1891385993Medicaid