Provider Demographics
NPI:1104495159
Name:EDWARDS, RAQUEL LATRICE (LLMSW, CAADC-DP)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LATRICE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LLMSW, CAADC-DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20812 LITTLESTONE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-2332
Mailing Address - Country:US
Mailing Address - Phone:586-945-7563
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:586-468-4505
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801107671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker