Provider Demographics
NPI:1093420549
Name:WELLS, LATOYA (LPC, CSOTP)
Entity type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE F1
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3350
Mailing Address - Country:US
Mailing Address - Phone:757-204-1866
Mailing Address - Fax:757-782-4004
Practice Address - Street 1:3630 GEORGE WASHINGTON MEM HWY STE F1
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3350
Practice Address - Country:US
Practice Address - Phone:757-204-1866
Practice Address - Fax:757-782-4004
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009889101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health