Provider Demographics
NPI:1821144254
Name:WORTHEN, LATONJYA (BS)
Entity Type:Individual
Prefix:MISS
First Name:LATONJYA
Middle Name:
Last Name:WORTHEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:LATONJYA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN
Mailing Address - Street 1:411 PICASSO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2649
Mailing Address - Country:US
Mailing Address - Phone:510-593-5920
Mailing Address - Fax:
Practice Address - Street 1:411 PICASSO CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2649
Practice Address - Country:US
Practice Address - Phone:916-526-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA95043260163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health