Provider Demographics
NPI:1033460373
Name:POLLARD, LATONIA S (LMSW)
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:S
Last Name:POLLARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LATONIA
Other - Middle Name:
Other - Last Name:GRISSOM BLUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3545 28TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3201
Mailing Address - Country:US
Mailing Address - Phone:210-401-4835
Mailing Address - Fax:
Practice Address - Street 1:9205 TURNER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1189
Practice Address - Country:US
Practice Address - Phone:575-693-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-080351041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool