Provider Demographics
NPI:1861701740
Name:THOMAS, LATONYA R (MSW)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 DESOTO AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4440
Mailing Address - Country:US
Mailing Address - Phone:662-592-5397
Mailing Address - Fax:662-627-2442
Practice Address - Street 1:122 DESOTO AVE STE 109
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4440
Practice Address - Country:US
Practice Address - Phone:662-592-5397
Practice Address - Fax:662-627-2442
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA1041C0700X
VA1041C0700X
AR1041C0700X
MS1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health