Healthcare Provider Details

I. General information

NPI: 1629306956
Provider Name (Legal Business Name): DONNA LATIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E SIX FORKS RD STE 218
RALEIGH NC
27609-7755
US

IV. Provider business mailing address

211 E SIX FORKS RD STE 218
RALEIGH NC
27609-7755
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-5176
  • Fax: 919-747-9175
Mailing address:
  • Phone: 252-258-5176
  • Fax: 919-747-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1104808
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1104808
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: