Provider Demographics
NPI:1376007633
Name:WARD, LATOSHA R (MHP)
Entity Type:Individual
Prefix:MS
First Name:LATOSHA
Middle Name:R
Last Name:WARD
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:LATOSHA
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1965 SAXON VALLEY CIR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-6008
Mailing Address - Country:US
Mailing Address - Phone:404-797-6632
Mailing Address - Fax:
Practice Address - Street 1:146 MCGEHEE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5012
Practice Address - Country:US
Practice Address - Phone:225-275-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health