Provider Demographics
NPI:1528249455
Name:ARTIS, LATOYA SAMANTHA-LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:SAMANTHA-LEE
Last Name:ARTIS
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 1:436 MDG/SGHQ
Mailing Address - Street 2:300 TUSKEGEE BLVD
Mailing Address - City:DOVER AFB
Mailing Address - State:DE
Mailing Address - Zip Code:19902
Mailing Address - Country:US
Mailing Address - Phone:302-677-2674
Mailing Address - Fax:
Practice Address - Street 1:436 MDG/SGHQ
Practice Address - Street 2:300 TUSKEGEE BLVD
Practice Address - City:DOVER AFB
Practice Address - State:DE
Practice Address - Zip Code:19902
Practice Address - Country:US
Practice Address - Phone:302-677-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067141041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical