Provider Demographics
NPI:1699342055
Name:DJANIE, LATOYRIA (CAC)
Entity type:Individual
Prefix:
First Name:LATOYRIA
Middle Name:
Last Name:DJANIE
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W SCHUYLKILL RD APT 332
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-9622
Mailing Address - Country:US
Mailing Address - Phone:484-366-9871
Mailing Address - Fax:
Practice Address - Street 1:110 WESTON AVE # 2
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1352
Practice Address - Country:US
Practice Address - Phone:609-503-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health