Latanya Renee Maynard, MA
Individual provider Active NPI Counselor · Jacksonville, FL
NPI 1790259489 · NPPES record last updated Jan 15, 2019
Key facts
- NPI
- 1790259489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 1131 W 32ND St
Jacksonville, FL 32209-4094 - Phone
- (904) 866-5717
- NPI assigned
- Jan 15, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
1131 W 32ND St
Jacksonville, FL 32209-4094
Mailing address
2392 Edgewood Ave N
Jacksonville, FL 32254-1725
Phone (904) 781-7797
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.