Latavia Shantaye Agada, MA, LCSW
Social Worker, Clinical in Rockford, IL. Individual provider (NPI-1).
NPI number1417338799
StatusActive
Last updated in NPPESFeb 18, 2025
Details
- NPI
- 1417338799
- Entity type
- Individual (NPI-1)
- Name
- Latavia Shantaye Agada
- Credential
- MA, LCSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 12, 2015
- Certification date
- Feb 13, 2025
- Last updated
- Feb 18, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 149.018494 | IL | Yes |
| 104100000X | Social Worker | 150015210 | IL |
Practice location
2823 Glenwood Ave.Rockford, IL 61101
Phone 815-968-5342 · Fax 815-968-4656
Mailing address
2823 Glenwood AvenueRockford, IL 61101
Phone 815-968-5342
Other practice locations
8300 Esters Blvd Ste 900
Irving, TX 75063-2233
Irving, TX 75063-2233
Phone 415-424-4266
8280 Willow Oaks Corporate Dr Ste 600
Fairfax, VA 22031-4516
Fairfax, VA 22031-4516
Phone 415-424-4266
475 Biltmore Way Ste 109
Coral Gables, FL 33134-5724
Coral Gables, FL 33134-5724
Phone 415-424-4266
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