Eminence Image, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EMINENCE IMAGE, LLC

Practice address

1220 North St
Fayetteville, NC 28301-4413

Phone

(910) 853-2184

NPI assigned

Aug 23, 2016

Organization subpart

No

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

Authorized official

Name

Miss Latasha M Bethea, MS

Title

Ceo/Owner

Phone

(910) 853-2184

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1922553692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 ELMWOOD AVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012109",
            "telephone_number": "910-853-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 NORTH ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014413",
            "telephone_number": "910-853-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMINENCE IMAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-23",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "BETHEA",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "910-853-2184",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.