Provider Demographics
NPI:1386028694
Name:WILLIAMS, LATIA (BA)
Entity Type:Individual
Prefix:
First Name:LATIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 INTERNATIONAL DR APT 1230B
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1394
Mailing Address - Country:US
Mailing Address - Phone:734-717-6638
Mailing Address - Fax:
Practice Address - Street 1:2925 RUSSELL ST.
Practice Address - Street 2:TEAM MENTAL HEALTH SERVICES
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-396-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator