Provider Demographics
NPI:1770020513
Name:BROWN, LATOYA (MAADC II)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MAADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 SUN VALLEY DR
Mailing Address - Street 2:STE. A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2178
Mailing Address - Country:US
Mailing Address - Phone:573-353-0395
Mailing Address - Fax:573-616-3008
Practice Address - Street 1:1803 SUN VALLEY DR
Practice Address - Street 2:STE. A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2178
Practice Address - Country:US
Practice Address - Phone:573-353-0395
Practice Address - Fax:573-616-3008
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO9055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)