Provider Demographics
NPI:1235676818
Name:SCULLION, RACHEL (LMSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SCULLION
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20411 W 12 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6404
Mailing Address - Country:US
Mailing Address - Phone:866-703-1901
Mailing Address - Fax:
Practice Address - Street 1:4370 CHICAGO DR SW # 515
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1694
Practice Address - Country:US
Practice Address - Phone:616-287-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15152171M00000X
MI68011167901041C0700X
MI68010988721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator