Active NPI
Latonya Wilson, LLMSW
- Clinical Social Worker
- Brighton, MI
National Provider Identifier
1407490808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 680115910
- Practice address
- 2200 Genoa Business Park Dr Ste 100
Brighton, MI 48114-5328 - Phone
- (810) 449-7180
- Fax
- (248) 692-4936
- NPI assigned
- Oct 30, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Clinical Social Worker | 1041C0700X | 680115910 | MI | Primary |
Addresses
Primary practice location
2200 Genoa Business Park Dr Ste 100
Brighton, MI 48114-5328
Mailing address
1100 Torrey Rd Ste 100
Fenton, MI 48430-3327
Phone (810) 494-7180
Other practice location 1
1255 N Oakland Blvd
Waterford, MI 48327-1545
Phone (248) 599-8999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003247362 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 680115910 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646006400000",
"number": "1407490808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 TORREY RD STE 100",
"city": "FENTON",
"state": "MI",
"postal_code": "484303327",
"telephone_number": "810-494-7180",
"fax_number": "248-692-4936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 GENOA BUSINESS PARK DR STE 100",
"city": "BRIGHTON",
"state": "MI",
"postal_code": "481145328",
"telephone_number": "810-449-7180",
"fax_number": "248-692-4936"
}
],
"practiceLocations": [
{
"address_1": "1255 N Oakland Blvd",
"address_purpose": "LOCATION",
"city": "Waterford",
"state": "MI",
"postal_code": "483271545",
"country_code": "US",
"telephone_number": "248-599-8999",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "LATONYA",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-30",
"last_updated": "2022-02-28",
"certification_date": "2022-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "680115910",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1003247362",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brighton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.