Provider Demographics
NPI:1205205226
Name:SHELTON, MICHAEL (MS, CAC, CAADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MS, CAC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SOUTH 4TH STREET, SUITE 471
Mailing Address - Street 2:EQUILIBRIA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5025
Mailing Address - Country:US
Mailing Address - Phone:267-861-3685
Mailing Address - Fax:
Practice Address - Street 1:525 SOUTH 4TH STREET, SUITE 471
Practice Address - Street 2:EQUILIBRIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147
Practice Address - Country:US
Practice Address - Phone:267-861-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health