Provider Demographics
NPI:1780065334
Name:SMITH, LATROYAL
Entity type:Individual
Prefix:MS
First Name:LATROYAL
Middle Name:
Last Name:SMITH
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 1:139 BAKER ST # C
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1703
Mailing Address - Country:US
Mailing Address - Phone:804-651-6204
Mailing Address - Fax:434-336-1516
Practice Address - Street 1:139 BAKER ST # C
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1703
Practice Address - Country:US
Practice Address - Phone:804-651-6204
Practice Address - Fax:434-336-1516
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040086201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical