Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | P006057 | NC |
NPI | 1003100496 |
---|---|
Provider Name | Ms. Latonya Latrice Pompey |
First Address | Charlotte, NC 28212-5591 |
Second Address | Charlotte, NC 28212-5591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 03/06/2011 |