Healthcare Provider Details

I. General information

NPI: 1760795900
Provider Name (Legal Business Name): LATASHA SHAWNTAYA WILLIAMS M.A., LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 11/18/2021
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W MILWAUKEE ST
DETROIT MI
48202-2943
US

IV. Provider business mailing address

24478 PILGRIM
REDFORD MI
48239-3523
US

V. Phone/Fax

Practice location:
  • Phone: 313-344-9099
  • Fax:
Mailing address:
  • Phone: 810-336-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301014431
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: