Provider Demographics
NPI:1538310305
Name:BRABOY, LATISHA (PSYD,LLP,LMSW,ACSW)
Entity Type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:
Last Name:BRABOY
Suffix:
Gender:F
Credentials:PSYD,LLP,LMSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2007
Mailing Address - Country:US
Mailing Address - Phone:248-990-0484
Mailing Address - Fax:
Practice Address - Street 1:5737 HARVARD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2007
Practice Address - Country:US
Practice Address - Phone:248-990-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI6301014982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical