Provider Demographics
NPI:1720216799
Name:HOWARD, LATOYA DANIELLE (BA)
Entity Type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:DANIELLE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8050 103RD ST
Mailing Address - Street 2:APT C11
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6646
Mailing Address - Country:US
Mailing Address - Phone:904-463-3523
Mailing Address - Fax:904-677-8019
Practice Address - Street 1:4570 SAINT JOHNS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1848
Practice Address - Country:US
Practice Address - Phone:904-887-3624
Practice Address - Fax:904-677-8019
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL360358001Medicaid