Ellis, Latasha Michelle
Ellis, Latasha Michelle is an sole proprietor health care provider with primary practice located at 766 Hartness Rd , Statesville NC 28677-3425. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Ellis, Latasha Michelle can be contacted via phone (704) 380-3620.Contact Information
Primary practice address
766 Hartness Rd
Statesville NC 28677-3425
Phone: (704) 380-3620
Fax: (704) 380-3623
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | C005951 | North Carolina |
Profile Details
| NPI number | 1487832671 |
|---|---|
| LBN Legal business name | Ellis, Latasha Michelle |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 10th, 2008 |
| Last updated | Mar 8th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487832671 | NPPES |
| North Carolina | MEDICAID | 6106903 |
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