Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801033350 | MI |
NPI | 1003162850 |
---|---|
Provider Name | Debbie Shell |
First Address | Detroit, MI 48208 |
Second Address | Detroit, MI 48208-1105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 31/07/2012 |