Provider Information for 1669754271
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LATASHA SHANNON LMSW, CAADC
Sex: Female
NPI: 1669754271
Last Updated: 2020-03-31
Certification Date: 2020-03-31
Certification Date: 2020-03-31
Details
| Name | Value | ||||||||||||||||
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| NPI | 1669754271 | ||||||||||||||||
| Enumeration Date | 2011-09-09 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 447 FOREST AVE STE 1 PLYMOUTH, MI 48170-1721 United States Phone: 734-635-3499 | Fax: | ||||||||||||||||
| Primary Practice Address | 447 FOREST AVE STE 1 PLYMOUTH, MI 48170-1721 United States Phone: 734-635-3499 | Fax: | ||||||||||||||||
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