Individual
MRS. LATEASHA MCMULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
636 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625
(704) 978-1140
Mailing address
515 CLANTON RD, CHARLOTTE, NC 28217-1309
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NC
Other
Enumeration date
09/09/2018
Last updated
01/08/2019
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