Provider Demographics
NPI:1780125211
Name:MANGUM, LATONYA PATTERSON (MSW, LCSWA, LCASA)
Entity type:Individual
Prefix:MS
First Name:LATONYA
Middle Name:PATTERSON
Last Name:MANGUM
Suffix:
Gender:F
Credentials:MSW, LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PLOWLAN CT
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7910
Mailing Address - Country:US
Mailing Address - Phone:919-271-4459
Mailing Address - Fax:
Practice Address - Street 1:103 PLOWLAN CT
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7910
Practice Address - Country:US
Practice Address - Phone:919-271-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22975101YA0400X
NCP0106761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)