Provider Demographics
NPI:1215218730
Name:WHITE, LATOYA (BS)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SPRING GARDEN ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3212
Mailing Address - Country:US
Mailing Address - Phone:215-769-3561
Mailing Address - Fax:
Practice Address - Street 1:1217 SPRING GARDEN ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3212
Practice Address - Country:US
Practice Address - Phone:215-769-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker