Provider Demographics
NPI:1366165649
Name:THOMAS, LATANYA JOANIECE (LCADC)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:JOANIECE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:LATANYA
Other - Middle Name:JOANIECE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,LCADC
Mailing Address - Street 1:761 CUTHBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3417
Mailing Address - Country:US
Mailing Address - Phone:267-259-3759
Mailing Address - Fax:
Practice Address - Street 1:761 CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3417
Practice Address - Country:US
Practice Address - Phone:856-890-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00358100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)