Provider Demographics
NPI:1720255680
Name:INSIGHTFUL OPTIONS
Entity Type:Organization
Organization Name:INSIGHTFUL OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:SHAWNTAY
Authorized Official - Last Name:MCILWAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MHA, LPC, LCAS
Authorized Official - Phone:704-340-4666
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:PAW CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28130-0743
Mailing Address - Country:US
Mailing Address - Phone:704-340-4666
Mailing Address - Fax:
Practice Address - Street 1:1409 EAST BLVD
Practice Address - Street 2:SUITE 6B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5817
Practice Address - Country:US
Practice Address - Phone:704-340-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6691101YP2500X
NC1296251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103719Medicaid
NC6006425Medicaid