Provider Demographics
NPI:1467110478
Name:PICKETT, LATONJA N (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:LATONJA
Middle Name:N
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 TANGLE RIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0029
Mailing Address - Country:US
Mailing Address - Phone:980-225-2880
Mailing Address - Fax:
Practice Address - Street 1:1124 TANGLE RIDGE DR SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0029
Practice Address - Country:US
Practice Address - Phone:980-225-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP01711441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical