Provider Demographics
NPI:1629409602
Name:LASHORE, TAKISHA (LMSW)
Entity Type:Individual
Prefix:
First Name:TAKISHA
Middle Name:
Last Name:LASHORE
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 1:42517 LILLEY POINTE DR # 7
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3854
Mailing Address - Country:US
Mailing Address - Phone:734-646-6312
Mailing Address - Fax:
Practice Address - Street 1:42517 LILLEY POINTE DR # 7
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3854
Practice Address - Country:US
Practice Address - Phone:734-646-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088966104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker