Provider Demographics
NPI:1063771194
Name:WHITE, LATONYA (LPC)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GLORIEUX ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1703
Mailing Address - Country:US
Mailing Address - Phone:973-699-1337
Mailing Address - Fax:973-763-8243
Practice Address - Street 1:2130 MILLBURN AVE STE D1
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3749
Practice Address - Country:US
Practice Address - Phone:973-699-1337
Practice Address - Fax:973-763-8243
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00426900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional