Provider Demographics
NPI:1467213785
Name:DIVERS, LTANYA R
Entity Type:Individual
Prefix:
First Name:LTANYA
Middle Name:R
Last Name:DIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3102
Mailing Address - Country:US
Mailing Address - Phone:202-971-2823
Mailing Address - Fax:
Practice Address - Street 1:5211 AUTH RD
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4339
Practice Address - Country:US
Practice Address - Phone:202-257-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool