Provider Demographics
NPI:1710403399
Name:JOHNSON, LATONIA SAUNDERS (PHD, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:SAUNDERS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 STACIE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9216
Mailing Address - Country:US
Mailing Address - Phone:252-264-2091
Mailing Address - Fax:
Practice Address - Street 1:1400 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4510
Practice Address - Country:US
Practice Address - Phone:252-331-0322
Practice Address - Fax:252-331-0320
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0106301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical