Provider Demographics
NPI:1942769625
Name:LATOYA NELSON ENTERPRISES, LLC
Entity Type:Organization
Organization Name:LATOYA NELSON ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-805-6688
Mailing Address - Street 1:5439 TRALEE PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4437
Mailing Address - Country:US
Mailing Address - Phone:919-805-6688
Mailing Address - Fax:919-800-3399
Practice Address - Street 1:211 E SIX FORKS RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7753
Practice Address - Country:US
Practice Address - Phone:919-410-6707
Practice Address - Fax:919-800-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)