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General NPI Number Information
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NPI Number | 1174832174
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Entity Type | Individual
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Provider Name | LATOYA BERNICE GATHERS ED.D
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Gender | Female
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Dates
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Enumeration Date | 09/25/2010
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 1632 9TH AVE
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City | CONWAY
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State | SC
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Zip | 29527-4848
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Country | US
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Telephone | 843-485-5596
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Fax |
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Provider Business Mailing Address
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Address Line | 1908A HAWKINS ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-3078
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Country | US
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Telephone | 843-485-5596
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Fax | 843-546-0257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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