Individual
DESTINY ANTANAY-LAMARRIA FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
35425 W. MICHIGAN AVE, WAYNE, MI 48184
(734) 467-7600
Mailing address
35425 W MICHIGAN AVE, WAYNE, MI 48184-9800
(734) 467-7600
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
156F00000X
Technician/Technologist
—
—
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
11/06/2017
Last updated
07/19/2021
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