Provider Demographics
NPI:1669960118
Name:LATTIMORE, JAYNA JEANETTE (LMFTA)
Entity type:Individual
Prefix:
First Name:JAYNA
Middle Name:JEANETTE
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 HOLLISWOOD CT APT 923
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3132
Mailing Address - Country:US
Mailing Address - Phone:843-637-9487
Mailing Address - Fax:
Practice Address - Street 1:1400 WILLOW LN
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3551
Practice Address - Country:US
Practice Address - Phone:336-667-5151
Practice Address - Fax:336-667-5048
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12091A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist