Provider Demographics
NPI:1174260350
Name:MARTIN, LATOYA K
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LATOYA
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12397 SAN JOSE BLVD APT 1411
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2823
Mailing Address - Country:US
Mailing Address - Phone:772-342-5542
Mailing Address - Fax:
Practice Address - Street 1:12397 SAN JOSE BLVD APT 1411
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2823
Practice Address - Country:US
Practice Address - Phone:772-342-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor