Provider Demographics
NPI:1285248799
Name:CONLEY, LACHONTA ALISE (BSW)
Entity type:Individual
Prefix:
First Name:LACHONTA
Middle Name:ALISE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 BEAUFAIT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1372
Mailing Address - Country:US
Mailing Address - Phone:313-267-9777
Mailing Address - Fax:
Practice Address - Street 1:12594 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1416
Practice Address - Country:US
Practice Address - Phone:313-267-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty