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General NPI Number Information
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NPI Number | 1619839362
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Entity Type | Individual
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Provider Name | DARLENE LATSHAW LMBT
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1848 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27608-2730
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Country | US
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Telephone | 919-443-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 12201 MERIDIAN MARKET DR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-3812
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Country | US
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Telephone | 610-960-1256
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 21993
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License Number State | NC
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