Provider Demographics
NPI:1609471317
Name:EDWARDS, LATANYA K
Entity Type:Individual
Prefix:MS
First Name:LATANYA
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 AIRPORT BLVD APT 314
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-8358
Mailing Address - Country:US
Mailing Address - Phone:347-499-6551
Mailing Address - Fax:
Practice Address - Street 1:851 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18519-1759
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health