Provider Demographics
NPI:1760278956
Name:POWERS, LATOSHA RENEE (APC)
Entity type:Individual
Prefix:
First Name:LATOSHA
Middle Name:RENEE
Last Name:POWERS
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7093 DOUBLE PINE CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-6315
Mailing Address - Country:US
Mailing Address - Phone:443-315-9808
Mailing Address - Fax:
Practice Address - Street 1:2815 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6857
Practice Address - Country:US
Practice Address - Phone:706-478-7014
Practice Address - Fax:706-716-6268
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health