Provider Demographics
NPI:1174254254
Name:SHINGLETON, MARIE ELIZABETH (BSW, QIDP, QMHP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ELIZABETH
Last Name:SHINGLETON
Suffix:
Gender:F
Credentials:BSW, QIDP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 MERCANTILE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1207
Mailing Address - Country:US
Mailing Address - Phone:313-827-0764
Mailing Address - Fax:313-827-0767
Practice Address - Street 1:15200 MERCANTILE DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1207
Practice Address - Country:US
Practice Address - Phone:313-827-0764
Practice Address - Fax:313-827-0767
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852090499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health