Provider Demographics
NPI:1285423764
Name:THORNTON, LATORIA KYANA (MSW)
Entity type:Individual
Prefix:
First Name:LATORIA
Middle Name:KYANA
Last Name:THORNTON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 SAINT THOMAS DR APT 402
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2177
Mailing Address - Country:US
Mailing Address - Phone:434-941-3486
Mailing Address - Fax:434-941-3486
Practice Address - Street 1:6100 RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3314
Practice Address - Country:US
Practice Address - Phone:434-941-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD307761041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool