Provider Demographics
NPI:1659870962
Name:EDWARDS, LATOYA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:NICOLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W BRAMBLETON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1505
Mailing Address - Country:US
Mailing Address - Phone:757-303-1795
Mailing Address - Fax:757-500-7866
Practice Address - Street 1:250 W BRAMBLETON AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1505
Practice Address - Country:US
Practice Address - Phone:757-303-1795
Practice Address - Fax:757-500-7866
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040103571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical