Provider Demographics
NPI:1801229141
Name:KENNER, LATOYA (MS, BCC)
Entity Type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:
Last Name:KENNER
Suffix:
Gender:F
Credentials:MS, BCC
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:
Other - Last Name:KENNER-STROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3415 OLD HIGHWAY 41 STE 750
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1028
Mailing Address - Country:US
Mailing Address - Phone:678-574-8313
Mailing Address - Fax:
Practice Address - Street 1:3415 OLD HIGHWAY 41 STE 750
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1028
Practice Address - Country:US
Practice Address - Phone:678-574-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor