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NPI Code Detail

MEDICARE: LATIA PORTER LLMSW

MEDICARE: LATIA PORTER LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6851106971MI

General Provider Information

NPI Number : 1477318863
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATIA PORTER LLMSW
Provider Business Mailing Address
First Line : 20236 ASHTON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48219-1559
Country : US
Telephone Number : 313-454-9695
Fax Number :
Provider Business Practice Location Address
First Line : 12703 W 7 MILE RD
Second Line :
City : DETROIT
State : MI
Zip : 48235-1302
Country : US
Telephone Number : 313-694-3886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2024
Last Update Date : 02/15/2024

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Directions to “ LATIA PORTER LLMSW” Practice Location

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