Provider Demographics
NPI:1063920387
Name:CARTER-CHAVIS, LATISHA FAY (LCASA)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:FAY
Last Name:CARTER-CHAVIS
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:LATISHA
Other - Middle Name:FAY
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 CLYBORN CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9356
Mailing Address - Country:US
Mailing Address - Phone:910-739-9160
Mailing Address - Fax:
Practice Address - Street 1:2200 CLYBORN CHURCH RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360
Practice Address - Country:US
Practice Address - Phone:910-739-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24365101YA0400X
NCP0103761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical