Provider Demographics
NPI:1679993695
Name:LATIMER, ABIGAIL (CSW)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LATIMER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:HAROUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:269 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2126
Mailing Address - Country:US
Mailing Address - Phone:859-987-6127
Mailing Address - Fax:
Practice Address - Street 1:269 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2126
Practice Address - Country:US
Practice Address - Phone:859-987-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid