Provider Demographics
NPI:1932535176
Name:MELVIN, LATARSHA FORD (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:LATARSHA
Middle Name:FORD
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 E NC HIGHWAY 54 STE C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2483
Mailing Address - Country:US
Mailing Address - Phone:919-475-7499
Mailing Address - Fax:
Practice Address - Street 1:2003 E NC HIGHWAY 54 STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2483
Practice Address - Country:US
Practice Address - Phone:919-475-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP015645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health