Provider Demographics
NPI:1346771961
Name:ALTIZER-COMPTON, LETONYA SHERYL
Entity type:Individual
Prefix:MRS
First Name:LETONYA
Middle Name:SHERYL
Last Name:ALTIZER-COMPTON
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 1:230 CHARWOOD DR STE E
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2505
Mailing Address - Country:US
Mailing Address - Phone:276-971-9465
Mailing Address - Fax:276-628-5752
Practice Address - Street 1:230 CHARWOOD DR STE E
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2505
Practice Address - Country:US
Practice Address - Phone:276-971-9465
Practice Address - Fax:276-628-5190
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1620121Medicaid