Provider Demographics
NPI:1891099859
Name:BECTON, LATASHA Y (PHD, LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:Y
Last Name:BECTON
Suffix:
Gender:F
Credentials:PHD, LCMHC, LCAS
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:Y
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPC, LCAS, CCS
Mailing Address - Street 1:2827 WILD POPLAR WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-575-8985
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD MILL CIRCLE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2701
Practice Address - Country:US
Practice Address - Phone:336-575-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8135101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
NC2734101YA0400X
NC2734-A101YA0400X
101YM0800X
NCA8135101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health