Provider Demographics
NPI:1063266476
Name:PERRY, LATOYA MICHELLE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:MICHELLE
Last Name:PERRY
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 1:1811 W NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8100
Mailing Address - Country:US
Mailing Address - Phone:919-208-7588
Mailing Address - Fax:
Practice Address - Street 1:1811 W NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8100
Practice Address - Country:US
Practice Address - Phone:919-208-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician