Provider Demographics
NPI:1609345800
Name:STANLEY, LATIEYA BRIANNA (LCSWA)
Entity Type:Individual
Prefix:
First Name:LATIEYA
Middle Name:BRIANNA
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5204
Mailing Address - Country:US
Mailing Address - Phone:252-633-3855
Mailing Address - Fax:252-633-1548
Practice Address - Street 1:800 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-633-3855
Practice Address - Fax:252-633-1548
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0126711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical