Provider Demographics
NPI:1881230282
Name:DOWDELL, LATICE RENEE
Entity Type:Individual
Prefix:MS
First Name:LATICE
Middle Name:RENEE
Last Name:DOWDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24864 GREENBRIER AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1473
Mailing Address - Country:US
Mailing Address - Phone:313-445-6440
Mailing Address - Fax:
Practice Address - Street 1:43828 MEDEA DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1299
Practice Address - Country:US
Practice Address - Phone:313-808-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service