Provider Demographics
NPI:1417297987
Name:LATIF, RABIA (TLLP)
Entity Type:Individual
Prefix:
First Name:RABIA
Middle Name:
Last Name:LATIF
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 TELEGRAPH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6860
Mailing Address - Country:US
Mailing Address - Phone:734-262-4386
Mailing Address - Fax:734-661-4501
Practice Address - Street 1:12345 TELEGRAPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6860
Practice Address - Country:US
Practice Address - Phone:734-262-4386
Practice Address - Fax:734-661-4501
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015158103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist