Provider Demographics
NPI:1225169899
Name:EDWARDS, LATOYA (LMSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 RUE ROYALE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364
Mailing Address - Country:US
Mailing Address - Phone:870-270-2665
Mailing Address - Fax:
Practice Address - Street 1:1825 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3409
Practice Address - Country:US
Practice Address - Phone:870-630-2328
Practice Address - Fax:870-630-2348
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1606-M101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health