Provider Demographics
NPI:1114498581
Name:REMBERT, LATOYA N (OWNER)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:N
Last Name:REMBERT
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 BARRETT CREEK PKWY APT 142
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4927
Mailing Address - Country:US
Mailing Address - Phone:678-698-8871
Mailing Address - Fax:
Practice Address - Street 1:288 S MAIN ST STE 500&600
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7916
Practice Address - Country:US
Practice Address - Phone:678-698-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty