Healthcare Provider Details

I. General information

NPI: 1245505379
Provider Name (Legal Business Name): LATCH KEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CHERRY ST STE 60
WINSTON SALEM NC
27105-2500
US

IV. Provider business mailing address

4401 CHERRY ST STE 60
WINSTON SALEM NC
27105-2500
US

V. Phone/Fax

Practice location:
  • Phone: 336-416-6032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE L DRAKE
Title or Position: NC DIRECTOR
Credential:
Phone: 336-416-6032