Provider Demographics
NPI:1619641867
Name:CONNER, LATOYA JEWELLDINE (LCSWA)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:JEWELLDINE
Last Name:CONNER
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 1:8533 WREN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6179
Mailing Address - Country:US
Mailing Address - Phone:980-349-5777
Mailing Address - Fax:
Practice Address - Street 1:507 W INNES ST STE 230
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4265
Practice Address - Country:US
Practice Address - Phone:980-349-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0151231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical