Provider Demographics
NPI:1306036470
Name:WINFORD, LATRINA DEVONNE (LPCS)
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:DEVONNE
Last Name:WINFORD
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24551
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4551
Mailing Address - Country:US
Mailing Address - Phone:336-577-6652
Mailing Address - Fax:336-464-2071
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR
Practice Address - Street 2:25
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-577-6652
Practice Address - Fax:336-464-2071
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1635Medicaid
NC6103689Medicaid