Healthcare Provider Details

I. General information

NPI: 1730640566
Provider Name (Legal Business Name): LATOYA EWERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTERSTONE CLARKSVILLE HARRIET COHN CENTER 511 8TH STREET
CLARKSVILLE TN
37040
US

IV. Provider business mailing address

CENTERSTONE CLARKSVILLE HARRIET COHN CENTER 511 8TH STREET
CLARKSVILLE TN
37040
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: