Healthcare Provider Details

I. General information

NPI: 1861868739
Provider Name (Legal Business Name): LATANYA ELLINGTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16840 JULIANA AVE
EASTPOINTE MI
48021-3078
US

IV. Provider business mailing address

16840 JULIANA AVE
EASTPOINTE MI
48021-3078
US

V. Phone/Fax

Practice location:
  • Phone: 313-614-5013
  • Fax:
Mailing address:
  • Phone: 313-614-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121557
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: