Provider Demographics
NPI:1497997316
Name:DAVIS, LATANYA A (LPC)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S PARK SQ NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8602
Mailing Address - Country:US
Mailing Address - Phone:678-883-2131
Mailing Address - Fax:770-419-5752
Practice Address - Street 1:120 S PARK SQ NE
Practice Address - Street 2:SUITE 203
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8602
Practice Address - Country:US
Practice Address - Phone:678-883-2131
Practice Address - Fax:770-419-5752
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional