Provider Demographics
NPI:1558628057
Name:SMITH, LATONYA L (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:LATONYA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-0762
Mailing Address - Country:US
Mailing Address - Phone:985-474-0125
Mailing Address - Fax:888-671-0753
Practice Address - Street 1:1011 NW CENTRAL AVE STE N
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422
Practice Address - Country:US
Practice Address - Phone:985-474-5455
Practice Address - Fax:888-671-0753
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3424101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health