Provider Demographics
NPI:1134316672
Name:MCCOY, LATONYA RENAE (LMSW)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:RENAE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 MCDOUGALL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3980
Mailing Address - Country:US
Mailing Address - Phone:313-208-2430
Mailing Address - Fax:
Practice Address - Street 1:641 MCDOUGALL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3980
Practice Address - Country:US
Practice Address - Phone:313-208-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010819751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical