Provider Demographics
NPI:1558012179
Name:COLE, LATOYA (NCC)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 HIGHWAY 8 APT I34
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-8506
Mailing Address - Country:US
Mailing Address - Phone:662-404-2516
Mailing Address - Fax:
Practice Address - Street 1:6914 AUTUMN OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9380
Practice Address - Country:US
Practice Address - Phone:662-408-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health