Provider Demographics
NPI:1184507642
Name:HIXONADAMS, LATONYA WENDY
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:WENDY
Last Name:HIXONADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30200 TELEGRAPH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4503
Mailing Address - Country:US
Mailing Address - Phone:248-451-3759
Mailing Address - Fax:
Practice Address - Street 1:3695 PINOAK ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1380
Practice Address - Country:US
Practice Address - Phone:313-685-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278241163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health