Provider Demographics
NPI:1861763484
Name:BLACK, LATANYA MARONI (MA)
Entity type:Individual
Prefix:MRS
First Name:LATANYA
Middle Name:MARONI
Last Name:BLACK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LATANYA
Other - Middle Name:MARONI
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5710 EXECUTIVE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1759
Mailing Address - Country:US
Mailing Address - Phone:410-744-8422
Mailing Address - Fax:410-744-8424
Practice Address - Street 1:5710 EXECUTIVE DR,
Practice Address - Street 2:SUITE 105
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1759
Practice Address - Country:US
Practice Address - Phone:410-744-8422
Practice Address - Fax:410-744-8424
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor