Healthcare Provider Details

I. General information

NPI: 1831627819
Provider Name (Legal Business Name): LATOSHA A LYMON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29201 TELEGRAPH RD STE 550
SOUTHFIELD MI
48034-7664
US

IV. Provider business mailing address

14800 ROSEMONT AVE
DETROIT MI
48223-2341
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0784
  • Fax: 248-213-0521
Mailing address:
  • Phone: 248-828-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018942
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: