Agada, Latavia Shantaye

Agada, Latavia Shantaye is an individual health care provider with primary practice located at 2823 Glenwood Ave. , Rockford IL 61101. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Agada, Latavia Shantaye can be contacted via phone (815) 968-5342.

Contact Information

Primary practice address
2823 Glenwood Ave. Rockford IL 61101
Phone: (815) 968-5342
Fax: (815) 968-4656
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X 150015210 Illinois
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149.018494 Illinois

Profile Details

NPI number 1417338799
LBN Legal business name Agada, Latavia Shantaye
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2015
Last updated Sep 1st, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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