Healthcare Provider Details

I. General information

NPI: 1407542624
Provider Name (Legal Business Name): ESSENCE LATOYA UKE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17320 W 12 MILE RD
SOUTHFIELD MI
48076-2100
US

IV. Provider business mailing address

46481 E OAK MANOR CT
CANTON MI
48187-5229
US

V. Phone/Fax

Practice location:
  • Phone: 734-536-8400
  • Fax:
Mailing address:
  • Phone: 734-536-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802089266
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118834
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: