Provider Demographics
NPI:1053098442
Name:BAILEY, LATOYA NATASHA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:NATASHA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 SPRING FOREST RD APT K5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2112
Mailing Address - Country:US
Mailing Address - Phone:252-402-4790
Mailing Address - Fax:
Practice Address - Street 1:902 SPRING FOREST RD APT K5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2112
Practice Address - Country:US
Practice Address - Phone:252-402-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician