Provider Demographics
NPI:1467274274
Name:PAYNE, LATONYA DANIELLE (MED, QMHP, CSAC-S)
Entity type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:DANIELLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MED, QMHP, CSAC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 OLD OCEAN VIEW RD APT B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-7790
Mailing Address - Country:US
Mailing Address - Phone:757-575-1515
Mailing Address - Fax:757-985-4718
Practice Address - Street 1:9313 SLOANE ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-4329
Practice Address - Country:US
Practice Address - Phone:757-985-4740
Practice Address - Fax:757-985-4718
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732005833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health