Provider Demographics
NPI:1215207790
Name:MAY, LATRICIA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:LATRICIA
Middle Name:NICOLE
Last Name:MAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LATRICIA
Other - Middle Name:NICOLE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3837 ADDISON GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3770
Mailing Address - Country:US
Mailing Address - Phone:850-545-8784
Mailing Address - Fax:
Practice Address - Street 1:4675 N SHALLOWFORD RD STE 202
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6309
Practice Address - Country:US
Practice Address - Phone:404-594-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0098371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherUPIN