Provider Demographics
NPI:1386292241
Name:FARRAR, LATANYA R (LCSW)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:R
Last Name:FARRAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4752 PEPPER TREE LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8421
Mailing Address - Country:US
Mailing Address - Phone:404-772-9056
Mailing Address - Fax:
Practice Address - Street 1:5950 LIVE OAK PKWY STE 240
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1743
Practice Address - Country:US
Practice Address - Phone:770-892-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical