Healthcare Provider Details

I. General information

NPI: 1891099859
Provider Name (Legal Business Name): LATASHA Y BECTON PHD, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATASHA Y HICKS PHD, LPC, LCAS, CCS

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLD MILL CIRCLE
WINSTON SALEM NC
27103-2701
US

IV. Provider business mailing address

1400 OLD MILL CIR STE D
WINSTON SALEM NC
27103-2977
US

V. Phone/Fax

Practice location:
  • Phone: 336-575-8985
  • Fax:
Mailing address:
  • Phone: 336-422-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8135
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA8135
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2734-A
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8135
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8135
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8135
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA8135
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2734
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: