Provider Demographics
NPI:1467228718
Name:STANLEY-BROWN, LATOSHA MARIE
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:MARIE
Last Name:STANLEY-BROWN
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 1:637 WELSH PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5722
Mailing Address - Country:US
Mailing Address - Phone:910-850-3025
Mailing Address - Fax:
Practice Address - Street 1:924 CHESTER CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4207
Practice Address - Country:US
Practice Address - Phone:910-850-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health