Provider Demographics
NPI:1861834251
Name:CARROLL, LATONYA MARIE (BS)
Entity Type:Individual
Prefix:MS
First Name:LATONYA
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560459
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-0459
Mailing Address - Country:US
Mailing Address - Phone:407-544-2170
Mailing Address - Fax:
Practice Address - Street 1:17711 NEAL DRIVE
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756
Practice Address - Country:US
Practice Address - Phone:407-544-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health