Provider Demographics
NPI:1679817597
Name:WADDELL, LATOYA CHEVELLE (LCMHCS, LCAS, CCS)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:CHEVELLE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:LCMHCS, LCAS, CCS
Other - Prefix:MS
Other - First Name:LATOYA
Other - Middle Name:CHEVELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, LCAS
Mailing Address - Street 1:4377 BAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2557
Mailing Address - Country:US
Mailing Address - Phone:336-264-5141
Mailing Address - Fax:
Practice Address - Street 1:4377 BAYLOR ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2557
Practice Address - Country:US
Practice Address - Phone:336-264-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3429101YA0400X
NC9186101YM0800X, 101YP2500X
NC572820101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor