Provider Demographics
NPI:1336597830
Name:MORRIS, LATASHA NICOLE
Entity Type:Individual
Prefix:MISS
First Name:LATASHA
Middle Name:NICOLE
Last Name:MORRIS
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 1:1358 W RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1837
Mailing Address - Country:US
Mailing Address - Phone:313-673-1345
Mailing Address - Fax:
Practice Address - Street 1:48661 S I 94 SERVCE DR
Practice Address - Street 2:308
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3312
Practice Address - Country:US
Practice Address - Phone:313-334-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI6401018449101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other