Provider Demographics
NPI:1326498890
Name:TAYLOR, SHEENA (LLBSW)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 STEVENS DR APT 302
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4529
Mailing Address - Country:US
Mailing Address - Phone:734-833-8946
Mailing Address - Fax:313-871-6655
Practice Address - Street 1:100 RIVER PLACE DR. SUITE 250
Practice Address - Street 2:WAYNE CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-871-2337
Practice Address - Fax:313-871-6655
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088875104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker