Provider Demographics
NPI:1457990962
Name:LAYTON, DEMETRIA R (LPC, MA)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:R
Last Name:LAYTON
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:DEMETRIA
Other - Middle Name:R
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6823 VAIL ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-6909
Mailing Address - Country:US
Mailing Address - Phone:318-820-8138
Mailing Address - Fax:
Practice Address - Street 1:2924 KNIGHT ST STE 426
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2414
Practice Address - Country:US
Practice Address - Phone:318-754-3560
Practice Address - Fax:318-779-0439
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional