Active NPI
Latoya Shena Wilson
- Clinical Social Worker
- Raleigh, NC
National Provider Identifier
1013704071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P021341
- Practice address
- 4761 Queen Pierrette St.
Raleigh, NC 27610-8706 - Phone
- (336) 268-5127
- NPI assigned
- Apr 23, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | P021341 | NC | |
| Peer Specialist | 175T00000X | P021341 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-30953 | NC | |
| Case Management Agency | 251B00000X | P021341 | NC | |
| Clinical Social Worker | 1041C0700X | P021341 | NC | Primary |
Addresses
Primary practice location
4761 Queen Pierrette St.
Raleigh, NC 27610-8706
Mailing address
4761 Queen Pierrette St
Raleigh, NC 27610-8706
Phone (336) 268-5127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-30953 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| P021341 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indigo Legends Enterprise LLC | Case Management | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1013704071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4761 QUEEN PIERRETTE ST",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276108706",
"telephone_number": "336-268-5127",
"fax_number": "336-268-5127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4761 QUEEN PIERRETTE ST.",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276108706",
"telephone_number": "336-268-5127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "LATOYA",
"middle_name": "SHENA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-23",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NC",
"license": "P021341",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NC",
"license": "P021341",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "LCAS-30953",
"primary": false
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "NC",
"license": "P021341",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P021341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.