Provider Demographics
NPI:1407459936
Name:DOTSON, LATOYA JO (EDD)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:JO
Last Name:DOTSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 S MICHIGAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3484
Mailing Address - Country:US
Mailing Address - Phone:773-819-5504
Mailing Address - Fax:
Practice Address - Street 1:2930 S MICHIGAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3484
Practice Address - Country:US
Practice Address - Phone:773-819-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health