Provider Demographics
NPI:1447530514
Name:CHEATHON, LATOYA S
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:S
Last Name:CHEATHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 DALLAS HWY SW STE 2021294
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2567
Mailing Address - Country:US
Mailing Address - Phone:678-253-8387
Mailing Address - Fax:
Practice Address - Street 1:1000 G ST STE 125
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-0894
Practice Address - Country:US
Practice Address - Phone:678-253-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT87215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist