MEDICARE: LATIA GUYTON LCMHC

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	101YM0800X	Mental Health Counselor	15890	NC
2	101YM0800X	Mental Health Counselor	A15890	NC

General Provider Information

NPI Number	:	1285213108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATIA GUYTON LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 605
Second Line	:
City	:	DUNN
State	:	NC
Zip	:	28335-0605
Country	:	US
Telephone Number	:	804-614-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 CROMWELL DR STE A
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5894
Country	:	US
Telephone Number	:	252-220-0420
Fax Number	:

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

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	11/03/2023

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