Individual
LATONYA LIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9002 161ST ST, JAMAICA, NY 11432-6108
(718) 520-1513
(718) 520-6460
Mailing address
3412 113TH ST # 2, CORONA, NY 11368-1425
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
33326-T
NY
Other
Enumeration date
10/24/2022
Last updated
11/29/2022
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