Individual provider · NPI-1

Latimer Breck Alexander V, LCSW-A, LCAS-A

Counselor, Addiction (Substance Use Disorder) · Greensboro, NC

NPI number1649627795
StatusActive
Last updated in NPPESApr 18, 2023

Details

NPI
1649627795
Entity type
Individual (NPI-1)
Name
Mr. Latimer Breck Alexander V
Credential
LCSW-A, LCAS-A
Sex
Male
Sole proprietor
Yes
Enumeration date
May 18, 2016
Certification date
Apr 18, 2023
Last updated
Apr 18, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)21985NCYes
1041C0700X Social Worker, ClinicalPO10755NC
1041C0700X Social Worker, ClinicalP015590NC

Practice location

5140 Dunstan Rd
Greensboro, NC 27405-9565

Phone 336-621-3381

Mailing address

5140 Dunstan Rd
Greensboro, NC 27405-9565

Phone 336-621-3381

Other practice locations

250 Executive Park Blvd Ste 120
Winston Salem, NC 27103-1534

Phone 367-702-4773

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