Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TP2701X | Group Psychotherapist |
NPI | 1114498581 |
---|---|
Provider Name | Latoya N Rembert |
First Address | Marietta, GA 30066-4927 |
Second Address | Alpharetta, GA 30009-7916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2018 |
Last Update Date | 11/12/2018 |