Healthcare Provider Details

I. General information

NPI: 1144139379
Provider Name (Legal Business Name): LATARSHA NICHOLE POWELL M.A, LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 SUNSET AVE STE 109
ROCKY MOUNT NC
27804-3751
US

IV. Provider business mailing address

2747 SUNSET AVE STE 109
ROCKY MOUNT NC
27804-3751
US

V. Phone/Fax

Practice location:
  • Phone: 252-985-3216
  • Fax:
Mailing address:
  • Phone: 252-985-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23372
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: