Provider Demographics
NPI:1346963840
Name:MCCOY, LATRICE
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATRICE
Other - Middle Name:NIKITA
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2905 MITCHELLVILLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3961
Mailing Address - Country:US
Mailing Address - Phone:202-769-4887
Mailing Address - Fax:
Practice Address - Street 1:2905 MITCHELLVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3961
Practice Address - Country:US
Practice Address - Phone:202-769-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13106101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor