Provider Demographics
NPI:1821457953
Name:BLANTON, LA-TANYA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LA-TANYA
Middle Name:DENISE
Last Name:BLANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LA-TANYA
Other - Middle Name:DENISE
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 7635
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0635
Mailing Address - Country:US
Mailing Address - Phone:757-377-5244
Mailing Address - Fax:
Practice Address - Street 1:3680 AVALON PARK EAST BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9372
Practice Address - Country:US
Practice Address - Phone:407-306-8441
Practice Address - Fax:888-413-8924
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR116911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical