Healthcare Provider Details

I. General information

NPI: 1720255680
Provider Name (Legal Business Name): INSIGHTFUL OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 03/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 EAST BLVD SUITE 6B
CHARLOTTE NC
28203-5817
US

IV. Provider business mailing address

PO BOX 743
PAW CREEK NC
28130-0743
US

V. Phone/Fax

Practice location:
  • Phone: 704-340-4666
  • Fax:
Mailing address:
  • Phone: 704-340-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6691
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1296
License Number StateNC

VIII. Authorized Official

Name: MS. LATASHA SHAWNTAY MCILWAINE
Title or Position: OWNER/ THERAPIST
Credential: MA, MHA, LPC, LCAS
Phone: 704-340-4666