Provider Demographics
NPI:1396081675
Name:ANDERSON, LATONYA NICOLE (MA, LPC)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:NICOLE
Last Name:ANDERSON
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 1:2152 MISTY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6756
Mailing Address - Country:US
Mailing Address - Phone:832-498-1449
Mailing Address - Fax:
Practice Address - Street 1:2152 MISTY HARBOR DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-6756
Practice Address - Country:US
Practice Address - Phone:832-498-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional