Provider Demographics
NPI:1992362719
Name:DAIS, LATASHA MONIQUE (LCMHC, LCAS, NCC)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:MONIQUE
Last Name:DAIS
Suffix:
Gender:F
Credentials:LCMHC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HUNTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8325
Mailing Address - Country:US
Mailing Address - Phone:252-549-0092
Mailing Address - Fax:
Practice Address - Street 1:604 ADLER LN
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5540
Practice Address - Country:US
Practice Address - Phone:252-549-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15016101YM0800X
NC25322101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health