Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | CI0133 | NV |
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033497151 |
---|---|
Provider Name | Latonya Reashawn Gaston |
First Address | North Las Vegas, NV 89030-4707 |
Second Address | North Las Vegas, NV 89030-4707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2011 |
Last Update Date | 30/06/2014 |