Provider Demographics
NPI:1922257898
Name:BROWN, LATASHA (LPC)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 SPRING VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8849
Mailing Address - Country:US
Mailing Address - Phone:803-448-1331
Mailing Address - Fax:803-324-5111
Practice Address - Street 1:200 E WOODLAWN RD
Practice Address - Street 2:BUILDING 1--SUITE 225 E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2303
Practice Address - Country:US
Practice Address - Phone:704-620-8273
Practice Address - Fax:704-529-1400
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104012Medicaid