Provider Demographics
NPI:1962853390
Name:FRANKLIN-JACKSON, LATOYA (CSW)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:FRANKLIN-JACKSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 COWBOY LN
Mailing Address - Street 2:LOT 70
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 COWBOY LN
Practice Address - Street 2:LOT 70
Practice Address - City:CALHOUN
Practice Address - State:LA
Practice Address - Zip Code:71225
Practice Address - Country:US
Practice Address - Phone:318-789-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13997104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker