Provider Demographics
NPI:1619734027
Name:ARMISTEAD, LATOYA SHANTELL
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:SHANTELL
Last Name:ARMISTEAD
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 1:424 LANDING DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-5468
Mailing Address - Country:US
Mailing Address - Phone:757-969-0485
Mailing Address - Fax:
Practice Address - Street 1:431 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3187
Practice Address - Country:US
Practice Address - Phone:803-278-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health