Provider Demographics
NPI:1679449649
Name:WARD, LATRICE ALICI'A (CHW)
Entity type:Individual
Prefix:MS
First Name:LATRICE
Middle Name:ALICI'A
Last Name:WARD
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3724
Mailing Address - Country:US
Mailing Address - Phone:313-416-6262
Mailing Address - Fax:
Practice Address - Street 1:15400 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3724
Practice Address - Country:US
Practice Address - Phone:313-416-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker