MEDICARE: LATONYA ANN BADGER LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A15190	NC

General Provider Information

NPI Number	:	1174174742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA ANN BADGER LPCA

Provider Business Mailing Address
First Line	:	3602 CANNOLD CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-6198
Country	:	US
Telephone Number	:	919-520-8039
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 CANNOLD CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-6198
Country	:	US
Telephone Number	:	919-520-8039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	10/08/2019

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