Individual
MS. LATHAY COLTRANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3811 REPON ST, GREENSBORO, NC 27407-5536
(336) 669-2819
(336) 299-9758
Mailing address
PO BOX 79113, GREENSBORO, NC 27417-9113
(336) 669-2819
(336) 299-9758
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366594715
—
NC
Enumeration date
09/21/2021
Last updated
09/21/2021
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