Provider Demographics
NPI:1912397241
Name:SMALLS, LATOYA (PHD, LPC, BSL, NCC)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:SMALLS
Suffix:
Gender:F
Credentials:PHD, LPC, BSL, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8375
Mailing Address - Country:US
Mailing Address - Phone:917-753-9597
Mailing Address - Fax:
Practice Address - Street 1:370 MEMORIAL PARKWAY
Practice Address - Street 2:FAMILY GUIDANCE CENTER OF WARREN COUNTY
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1580
Practice Address - Country:US
Practice Address - Phone:908-454-4470
Practice Address - Fax:908-454-5317
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001067103K00000X
PAPC017419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst