Basic Information
| Provider Information | |||||||||
| NPI: | 1669960118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LATTIMORE | ||||||||
| FirstName: | JAYNA | ||||||||
| MiddleName: | JEANETTE | ||||||||
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| Credential: | LMFTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7820 HOLLISWOOD CT APT 923 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282173132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436379487 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 WILLOW LN | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366675151 | ||||||||
| FaxNumber: | 3366675048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 11/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 12091A | NC | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.