# GREENE MCILWAINE FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336928993
- **Authorized official:** DR. LATASHA MCILWAINE EDD, LCMHCS, LCAS (PRESIDENT)
- **Authorized official phone:** (704) 340-4666

## Contact information

- **Practice address:** 615 E 6TH ST, CHARLOTTE, NC 28202-2918
- **Practice address phone:** (704) 492-1105
- **Mailing address:** PO BOX 743, PAW CREEK, NC 28130-0743
- **Mailing address phone:** (704) 340-4666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |

## Other

- **Enumeration date:** 09/25/2023
- **Last updated:** 09/25/2023