Healthcare Provider Details

I. General information

NPI: 1770403123
Provider Name (Legal Business Name): LATOYA THOMIKA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 372
IRMO SC
29063-0372
US

IV. Provider business mailing address

54 JOY RD
CAMDEN SC
29020-9754
US

V. Phone/Fax

Practice location:
  • Phone: 803-913-8567
  • Fax:
Mailing address:
  • Phone: 839-432-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: