Provider Demographics
NPI:1417582545
Name:HARLEY, LATOYA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:HARLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ANDREWS RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1129
Mailing Address - Country:US
Mailing Address - Phone:919-292-8601
Mailing Address - Fax:
Practice Address - Street 1:108 HAY ST STE 216
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5686
Practice Address - Country:US
Practice Address - Phone:919-292-8601
Practice Address - Fax:336-634-0444
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012941363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty