1245948827 NPI number — LATOYA D DUFF BSW, QMHP

Table of content: LATOYA D DUFF BSW, QMHP (NPI 1245948827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245948827 NPI number — LATOYA D DUFF BSW, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFF
Provider First Name:
LATOYA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSW, QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245948827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11815 FOUNTAIN WAY STE 300 #7734
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-718-7425
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11815 FOUNTAIN WAY STE 300 #7734
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-718-7425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0732006749 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 92-0807150 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".