Healthcare Provider Details

I. General information

NPI: 1861701740
Provider Name (Legal Business Name): LATONYA R THOMAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DESOTO AVE STE 109
CLARKSDALE MS
38614-4440
US

IV. Provider business mailing address

122 DESOTO AVE STE 109
CLARKSDALE MS
38614-4440
US

V. Phone/Fax

Practice location:
  • Phone: 662-592-5397
  • Fax: 662-627-2442
Mailing address:
  • Phone: 662-592-5397
  • Fax: 662-627-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31704
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTH00946983
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-5972
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.61423143
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11528-C
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015147
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22932
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: