Provider Demographics
NPI:1679815849
Name:SHELTON, LATONYA NICOLLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:NICOLLE
Last Name:SHELTON
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 1:707 MAIN ST # 243
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3605
Mailing Address - Country:US
Mailing Address - Phone:615-606-2964
Mailing Address - Fax:
Practice Address - Street 1:210 25TH AVE N # 1220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1606
Practice Address - Country:US
Practice Address - Phone:615-606-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68581041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical