Provider Demographics
NPI:1679817597
Name:WADDELL, LATOYA CHEVELLE (MS, LPC, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:CHEVELLE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:MS, LPC, LCAS
Other - Prefix:MS
Other - First Name:LATOYA
Other - Middle Name:CHEVELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, LCAS
Mailing Address - Street 1:3713 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3713 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2111
Practice Address - Country:US
Practice Address - Phone:336-288-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9186101YP2500X
NC3429101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)