Provider Demographics
NPI:1376094748
Name:MCCREE, LATISHA (LICENSED PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:
Last Name:MCCREE
Suffix:
Gender:F
Credentials:LICENSED PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11767 ROSEMARY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1356
Mailing Address - Country:US
Mailing Address - Phone:313-283-4345
Mailing Address - Fax:313-499-1933
Practice Address - Street 1:11767 ROSEMARY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1356
Practice Address - Country:US
Practice Address - Phone:313-283-4345
Practice Address - Fax:313-499-1933
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator