Provider Demographics
NPI:1710429428
Name:PIERCE, LATONIA (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:LATONIA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 WEISNER ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-3906
Mailing Address - Country:US
Mailing Address - Phone:336-918-8913
Mailing Address - Fax:
Practice Address - Street 1:287 WEISNER ST
Practice Address - Street 2:287 WEISNER STREET
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3906
Practice Address - Country:US
Practice Address - Phone:336-918-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional