Provider Demographics
NPI:1609342732
Name:BURNS, LATONA (LPCA)
Entity Type:Individual
Prefix:
First Name:LATONA
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 HUNTING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9132
Mailing Address - Country:US
Mailing Address - Phone:910-554-4957
Mailing Address - Fax:
Practice Address - Street 1:110 BRANCHWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5900
Practice Address - Country:US
Practice Address - Phone:910-219-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional