Provider Demographics
NPI:1831963859
Name:AGARD, LATONYA L (NC FBPPC)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:L
Last Name:AGARD
Suffix:
Gender:F
Credentials:NC FBPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 RUSHING FALLS PL
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6975
Mailing Address - Country:US
Mailing Address - Phone:919-500-7623
Mailing Address - Fax:
Practice Address - Street 1:713 RUSHING FALLS PL
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-6975
Practice Address - Country:US
Practice Address - Phone:919-500-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral