Provider Demographics
NPI:1043842826
Name:HENDRICKS, LATONYA (LPC, LSOTP)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 ELKHORN TRL
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-2235
Mailing Address - Country:US
Mailing Address - Phone:979-492-6228
Mailing Address - Fax:
Practice Address - Street 1:4103 S TEXAS AVE STE 212
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4043
Practice Address - Country:US
Practice Address - Phone:979-987-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional