Provider Demographics
NPI:1902959596
Name:HARDY-DAVIS, LA'TONDA MARCHELLE (MFC)
Entity Type:Individual
Prefix:MRS
First Name:LA'TONDA
Middle Name:MARCHELLE
Last Name:HARDY-DAVIS
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2330
Mailing Address - Country:US
Mailing Address - Phone:714-264-9446
Mailing Address - Fax:714-538-7680
Practice Address - Street 1:571 N POPLAR ST
Practice Address - Street 2:SUITE G
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1023
Practice Address - Country:US
Practice Address - Phone:714-940-0068
Practice Address - Fax:714-940-0769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33BGFUOtherMENTAL HEALTH PLAN