Healthcare Provider Details

I. General information

NPI: 1285423764
Provider Name (Legal Business Name): LATORIA KYANA THORNTON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 RADIO STATION RD
LA PLATA MD
20646-3314
US

IV. Provider business mailing address

2009 SAINT THOMAS DR APT 402
WALDORF MD
20602-2177
US

V. Phone/Fax

Practice location:
  • Phone: 434-941-3486
  • Fax:
Mailing address:
  • Phone: 434-941-3486
  • Fax: 434-941-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number30776
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: