Provider Demographics
NPI:1154818524
Name:LAW, LATOYA (MA QP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:MA QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N BICKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2473
Mailing Address - Country:US
Mailing Address - Phone:919-729-0127
Mailing Address - Fax:
Practice Address - Street 1:216 N BICKETT BLVD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2473
Practice Address - Country:US
Practice Address - Phone:919-729-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health