Provider Demographics
NPI:1992135594
Name:CARTER, LATASHA M (LCSW)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:M
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 LAWNDALE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4132
Mailing Address - Country:US
Mailing Address - Phone:336-340-9466
Mailing Address - Fax:
Practice Address - Street 1:2820 LAWNDALE DR
Practice Address - Street 2:SUITE 112
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4132
Practice Address - Country:US
Practice Address - Phone:336-340-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0093561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical