Provider Demographics
NPI:1851649479
Name:HAMPTON, LATOYA NICOLE (LISW-S)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:NICOLE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 BAILEY RD
Mailing Address - Street 2:#2B
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5800
Mailing Address - Country:US
Mailing Address - Phone:216-408-6192
Mailing Address - Fax:
Practice Address - Street 1:832 MCKINLEY AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2463
Practice Address - Country:US
Practice Address - Phone:330-430-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 1200475 SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1851649479Medicare PIN