Latasha Shawntay McIlwaine, MA, MHA, LPC, LCAS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6691 Issued in NC

Practice address

1409 East Blvd
Suite 6B
Charlotte, NC 28203-5817

Phone

(704) 340-4666

Fax

(704) 969-7298

NPI assigned

Apr 25, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC, GA, NH, TX, AZ, MA, RI7 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 7

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  AZ, GA, MA, NC, NH, Professional, RI, TX

  Medicare reassignment NPD
• Greene McIlwaine Foundation

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1336928993
  NPD Authorized official
• Insightful Options

  • Professional Counselor
  • Charlotte, NC
  • NPI 1720255680
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238198400000",
    "number": "1063631331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743",
            "city": "PAW CREEK",
            "state": "NC",
            "postal_code": "281300743",
            "telephone_number": "704-340-4666",
            "fax_number": "704-969-7298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 EAST BLVD",
            "address_2": "SUITE 6B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035817",
            "telephone_number": "704-340-4666",
            "fax_number": "704-969-7298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCILWAINE",
        "first_name": "LATASHA",
        "middle_name": "SHAWNTAY",
        "credential": "MA, MHA, LPC, LCAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2009-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "6691",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1296",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6103719",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Renee McIlveen, CNM
• Byron McIlwain Jr., LCSWA
• Michael Cecil McIlwain, RPH
• Ronald McIlwain, LCAS-A
• Teresa Sires McIlwain, DOCTOR OF MINISTRY
• Lilly Grace McIncrow, MD
• Elizabeth Catherine McInnis, FNP
• Jazmyn Desira McInnis
• Meghan Leigh McInnis, NP
• Pamela L McInnis

• Professional Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.