Provider Demographics
NPI:1043592181
Name:HOLLOWAY, LETISHA MECHELL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LETISHA
Middle Name:MECHELL
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LETISHA
Other - Middle Name:MECHELL
Other - Last Name:NORRIS-POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6415 NORBURN WAY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6040
Mailing Address - Country:US
Mailing Address - Phone:517-332-0811
Mailing Address - Fax:517-332-4452
Practice Address - Street 1:5031 PARK LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3835
Practice Address - Country:US
Practice Address - Phone:517-332-0811
Practice Address - Fax:517-332-4452
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010917231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical