Provider Demographics
NPI:1720575855
Name:WARREN, LATONIA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:NICOLE
Last Name:WARREN
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 1:3210 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-2096
Mailing Address - Country:US
Mailing Address - Phone:225-936-7661
Mailing Address - Fax:
Practice Address - Street 1:3210 RIVERS EDGE DR
Practice Address - Street 2:
Practice Address - City:ADDIS
Practice Address - State:LA
Practice Address - Zip Code:70710-2096
Practice Address - Country:US
Practice Address - Phone:225-936-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical