LATAVIA SHANTAYE AGADA MA, LCSW
Individual Provider (NPI-1)
Active
Social Worker, Clinical
Provider Information
- NPI Number
1417338799- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MA, LCSW
- Status
- Active
Contact & Location
- Address
- 2823 GLENWOOD AVE., ROCKFORD, IL, 61101
- Phone
- (815) 968-5342
- Fax
- (815) 968-4656
Specialties & Taxonomies
Social Worker
License: IL #150015210
Social Worker, Clinical
Primary License: IL #149.018494