Provider Demographics
NPI:1033795240
Name:LOUDER, NATASHA GOMEZ (LCMHCA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:GOMEZ
Last Name:LOUDER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620134
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0102
Mailing Address - Country:US
Mailing Address - Phone:980-202-0979
Mailing Address - Fax:
Practice Address - Street 1:13105 ASHLEY MEADOW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4852
Practice Address - Country:US
Practice Address - Phone:704-287-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health