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Latesha Green
Intellectual and/or Developmental Disabilities Residential Treatment Facility in Charlotte, North Carolina
NPI 1972239127

Latesha Green is a Intellectual and/or Developmental Disabilities Residential Treatment Facility based in Charlotte, NC. Latesha Green practices in Charlotte, NC. The NPI Number for Latesha Green is 1972239127 and holds a License No. (North Carolina).

The current practice location address for Latesha Green is 3409 Dominion Green Dr, Charlotte, NC and can be reached out via phone at 704-906-4522. You can also correspond with Latesha Green through the mailing address at 3409 DOMINION GREEN DR, CHARLOTTE, NC - 28269-7932 (mailing address contact number: 704-906-4522).

Location: 3409 Dominion Green Dr, Charlotte, NC, 28269-7932
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1972239127
Provider Name
Latesha Green
Credential
Provider Entity Type
Individual
Gender
Female
Address
3409 Dominion Green Dr, Charlotte, NC, 28269-7932
Phone Number
704-906-4522
Fax Number
Provider Enumeration Date
07/29/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3409 Dominion Green Dr
City
Charlotte
State
North Carolina
Zip
28269-7932
Phone Number
704-906-4522
Fax Number
person
Provider Business Mailing Address Details
Address
3409 Dominion Green Dr
City
Charlotte
State
North Carolina
Zip
28269-7932
Phone Number
704-906-4522
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Developmental Disabilities
Taxonomy
261QD1600X
License No.
(North Carolina)
Definition
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
(North Carolina)
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
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