Provider Demographics
NPI:1457917338
Name:COLEMAN, LATOYA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 BRIARCLIFF DR APT O
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5299
Mailing Address - Country:US
Mailing Address - Phone:718-514-4753
Mailing Address - Fax:
Practice Address - Street 1:3428 BRIARCLIFF DR APT O
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5299
Practice Address - Country:US
Practice Address - Phone:718-514-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103736104100000X
NCP0170611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker