Provider Demographics
NPI:1447635750
Name:CAMPOS, LATOYA SHATAWN (LCMHC, LPC, LCPC)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:SHATAWN
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LCMHC, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 WESLEY CHAPEL STOUTS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7940
Mailing Address - Country:US
Mailing Address - Phone:704-542-5175
Mailing Address - Fax:
Practice Address - Street 1:2901 WESLEY CHAPEL STOUTS RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7940
Practice Address - Country:US
Practice Address - Phone:704-651-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10961101YP2500X
NJ37PC00832800101YP2500X
NC12445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional