Provider Demographics
NPI:1356828040
Name:MCDONALD, LATIA KELLY (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LATIA
Middle Name:KELLY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 SUNSEEKER DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-6143
Mailing Address - Country:US
Mailing Address - Phone:803-767-9263
Mailing Address - Fax:
Practice Address - Street 1:854 SUNSEEKER DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-6143
Practice Address - Country:US
Practice Address - Phone:803-767-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional