Provider Demographics
NPI:1083477566
Name:SAMUELS, SHANNON (LLMSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31600 TELEGRAPH RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4370
Mailing Address - Country:US
Mailing Address - Phone:248-792-8093
Mailing Address - Fax:
Practice Address - Street 1:31600 TELEGRAPH RD STE 120
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4370
Practice Address - Country:US
Practice Address - Phone:248-792-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical