MEDICARE: DR. LATORIA S FLEMING PHD, LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A14290	NC

General Provider Information

NPI Number	:	1255807343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATORIA S FLEMING PHD, LPCA

Provider Business Mailing Address
First Line	:	628 E LITTLETON RD
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-4830
Country	:	US
Telephone Number	:	252-578-0102
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ELM ST
Second Line	:
City	:	WELDON
State	:	NC
Zip	:	27890-1934
Country	:	US
Telephone Number	:	252-578-0102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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