Provider Demographics
NPI:1972137917
Name:MCCOY, LATISHA DANIELLE (MA,LPC)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:DANIELLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3124
Mailing Address - Country:US
Mailing Address - Phone:267-216-7548
Mailing Address - Fax:
Practice Address - Street 1:132 W MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-3124
Practice Address - Country:US
Practice Address - Phone:267-216-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty