MEDICARE: LATANYA GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		NC
2	101Y00000X	Counselor		NC

General Provider Information

NPI Number	:	1366305054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATANYA GREENE

Provider Business Mailing Address
First Line	:	1433 PLUMSTEAD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-3535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 PLUMSTEAD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-3535
Country	:	US
Telephone Number	:	704-877-7573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ LATANYA GREENE ” Practice Location

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