Provider Demographics
NPI:1841564457
Name:HOUSTON, LEATHIE M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LEATHIE
Middle Name:M
Last Name:HOUSTON
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 1:27372 PARKVIEW BLVD
Mailing Address - Street 2:APT 4308
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2834
Mailing Address - Country:US
Mailing Address - Phone:313-333-2052
Mailing Address - Fax:
Practice Address - Street 1:1270 DORIS RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2617
Practice Address - Country:US
Practice Address - Phone:248-276-8037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087995104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker