Provider Demographics
NPI:1912705047
Name:ECHOLS, NATISHA
Entity type:Individual
Prefix:
First Name:NATISHA
Middle Name:
Last Name:ECHOLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NATISHA
Other - Middle Name:
Other - Last Name:ECHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:418 PERSON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 PERSON ST STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5886
Practice Address - Country:US
Practice Address - Phone:910-483-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)