Provider Demographics
NPI:1922725191
Name:PIERCE, LATAWNA AVON
Entity Type:Individual
Prefix:
First Name:LATAWNA
Middle Name:AVON
Last Name:PIERCE
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 1:12840 S KIRKWOOD RD APT 113
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3829
Mailing Address - Country:US
Mailing Address - Phone:832-617-1695
Mailing Address - Fax:
Practice Address - Street 1:2006 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4960
Practice Address - Country:US
Practice Address - Phone:832-617-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker