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General NPI Number Information
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NPI Number | 1376146977
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Entity Type | Individual
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Provider Name | STEPHANIE LATKA LLPC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 19855 OUTER DR STE 300W
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City | DEARBORN
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State | MI
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Zip | 48124-2189
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Country | US
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Telephone | 313-359-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 PINE CREST CT
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City | JACKSON
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State | MI
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Zip | 49203-3200
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Country | US
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Telephone | 615-484-1849
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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