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NPI Code Detail

MEDICARE: LATASHA JUDY SPENCER LLPC

MEDICARE: LATASHA JUDY SPENCER LLPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor6401017425MI

General Provider Information

NPI Number : 1003469644
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATASHA JUDY SPENCER LLPC
Provider Business Mailing Address
First Line : 11105 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3317
Country : US
Telephone Number : 248-417-1784
Fax Number :
Provider Business Practice Location Address
First Line : 11105 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3317
Country : US
Telephone Number : 248-417-1784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2019
Last Update Date : 04/15/2024

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Directions to “ LATASHA JUDY SPENCER LLPC” Practice Location

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