Provider Demographics
NPI:1467994970
Name:MCLEOD, LATOYA (CTRS, LCSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:CTRS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 UPTAIN RD STE 509
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5675
Mailing Address - Country:US
Mailing Address - Phone:423-400-0107
Mailing Address - Fax:
Practice Address - Street 1:5751 UPTAIN RD STE 509
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5675
Practice Address - Country:US
Practice Address - Phone:423-400-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ062437Medicaid