Healthcare Provider Details

I. General information

NPI: 1104583236
Provider Name (Legal Business Name): LATANYA YVETTE MONROE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 GRAND WAILEA DR
HOPE MILLS NC
28348-8206
US

IV. Provider business mailing address

525 GRAND WAILEA DR APT 1028
HOPE MILLS NC
28348-8208
US

V. Phone/Fax

Practice location:
  • Phone: 910-322-2262
  • Fax:
Mailing address:
  • Phone: 910-322-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: