Individual provider · NPI-1

Deitra Latrice Fant, MA,NCC,LCPC,LPC

Counselor, Professional · Oxon Hill, MD

NPI number1699131896

StatusActive

Last updated in NPPESSep 29, 2026

Details

NPI: 1699131896
Entity type: Individual (NPI-1)
Name: Mrs. Deitra Latrice Fant
Credential: MA,NCC,LCPC,LPC
Sex: Female
Sole proprietor: Yes
Enumeration date: Jan 5, 2016
Certification date: Dec 29, 2025
Last updated: Sep 29, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
101YP2500X	Counselor, Professional	LC10267	MD	Yes
101YM0800X	Counselor, Mental Health	–	–
261QM0850X	Clinic/Center, Adult Mental Health	–	–
101YP2500X	Counselor, Professional	PRC15297	DC
171M00000X	Case Manager/Care Coordinator	–	–
172V00000X	Community Health Worker	–	–
261QM0855X	Clinic/Center, Adolescent and Children Mental Health	–	–
101YP2500X	Counselor, Professional	0701009874	VA
251S00000X	Community/Behavioral Health	–	–
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–
101YP2500X	Counselor, Professional	08861	LA
101YM0800X	Counselor, Mental Health	LC10267	MD

Practice location

120 Waterfront St Ste 420
Oxon Hill, MD 20745-1122

Phone 703-857-5354 · Fax 571-601-4607

Mailing address

120 Waterfront St Ste 420
Oxon Hill, MD 20745-1122

Phone 703-857-5354 · Fax 571-601-4607

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