Provider Demographics
NPI:1851034722
Name:JONES, LATOSHA SHERESA
Entity Type:Individual
Prefix:
First Name:LATOSHA
Middle Name:SHERESA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 MILITARY CUTOFF RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3638
Mailing Address - Country:US
Mailing Address - Phone:910-444-4771
Mailing Address - Fax:
Practice Address - Street 1:1437 MILITARY CUTOFF RD STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3638
Practice Address - Country:US
Practice Address - Phone:910-444-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health