Provider Demographics
NPI:1679035265
Name:HARDAWAY, LATITIA
Entity type:Individual
Prefix:
First Name:LATITIA
Middle Name:
Last Name:HARDAWAY
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 1:3030 EUCLID AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2518
Mailing Address - Country:US
Mailing Address - Phone:216-309-8111
Mailing Address - Fax:
Practice Address - Street 1:3320 BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1833
Practice Address - Country:US
Practice Address - Phone:216-309-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X
247000000X, 251S00000X, 320600000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171W00000XOther Service ProvidersContractor
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities