Provider Demographics
NPI:1174174742
Name:BADGER, LATONYA ANN (LPCA)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:ANN
Last Name:BADGER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 CANNOLD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6198
Mailing Address - Country:US
Mailing Address - Phone:919-520-8039
Mailing Address - Fax:
Practice Address - Street 1:3602 CANNOLD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6198
Practice Address - Country:US
Practice Address - Phone:919-520-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health