Basic Information
| Provider Information | |||||||||
| NPI: | 1760795900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LATASHA | ||||||||
| MiddleName: | SHAWNTAYA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A., LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24478 PILGRIM | ||||||||
| Address2: | |||||||||
| City: | REDFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482393523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103367430 | ||||||||
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| Practice Location | |||||||||
| Address1: | 707 W MILWAUKEE ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133449099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2010 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 6301014431 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.