Healthcare Provider Details

I. General information

NPI: 1508221706
Provider Name (Legal Business Name): LATOYA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 SOUTHFIELD RD
BIRMINGHAM MI
48009-3005
US

IV. Provider business mailing address

801 W BIG BEAVER RD STE 300
TROY MI
48084-4725
US

V. Phone/Fax

Practice location:
  • Phone: 734-245-7955
  • Fax:
Mailing address:
  • Phone: 734-245-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: