Provider Demographics
NPI:1902345408
Name:AVANT, LATRINA
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:
Last Name:AVANT
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 1:164 MAHONEY LN
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-9411
Mailing Address - Country:US
Mailing Address - Phone:478-973-0698
Mailing Address - Fax:
Practice Address - Street 1:164 MAHONEY LANE
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030
Practice Address - Country:US
Practice Address - Phone:478-973-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health