Provider Demographics
NPI:1932777802
Name:DALTON, LARITA PATRICE
Entity Type:Individual
Prefix:MS
First Name:LARITA
Middle Name:PATRICE
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 SAPPHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3584
Mailing Address - Country:US
Mailing Address - Phone:912-492-6828
Mailing Address - Fax:
Practice Address - Street 1:5641 SAPPHIRE CIR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3584
Practice Address - Country:US
Practice Address - Phone:912-492-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker