Provider Demographics
NPI:1669836920
Name:CARTER, LATONYA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:
Last Name:CARTER
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 1:1226 ROYAL DR SW STE O
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5926
Mailing Address - Country:US
Mailing Address - Phone:404-408-3916
Mailing Address - Fax:770-788-3281
Practice Address - Street 1:1226 ROYAL DR SW STE O
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5926
Practice Address - Country:US
Practice Address - Phone:404-408-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0059841041C0700X
GAMSW0065521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical