Doctor Name: | LATASHA SHAWNTAY MCILWAINE |
NPI Number: | 1063631331 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, MHA, LPC, LCAS |
License Number: | |
Business Practice Address: | 1409 East Blvd Suite 6b Charlotte, NC - 282035817 |
Business Phone Number: | 7043404666 |
Business Fax Number: | 7049697298 |
Mailing Address: | Po Box 743, PAW CREEK |
State: | NC |
Postal Code: | 281300743 |
Phone Number: | 7043404666 |
Fax Number: | 7049697298 |
NPI Enumeration Date: | 04/25/2007 |
NPI Last Update Date: | 03/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |