Provider Demographics
NPI:1003540089
Name:ELLIS, LATOYA DYAN (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:DYAN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 RED FOX CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-9253
Mailing Address - Country:US
Mailing Address - Phone:210-264-9948
Mailing Address - Fax:
Practice Address - Street 1:515 RED FOX CT
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-9253
Practice Address - Country:US
Practice Address - Phone:210-264-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-3518216171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA-3518216OtherNATIONAL BOARD FOR HEALTH & WELLNESS COACHING