Provider Demographics
NPI:1598034613
Name:MCDONALD, SHERONDA RAQUEL (LMSW)
Entity Type:Individual
Prefix:
First Name:SHERONDA
Middle Name:RAQUEL
Last Name:MCDONALD
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:PO BOX 252512
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-2512
Mailing Address - Country:US
Mailing Address - Phone:248-346-7256
Mailing Address - Fax:
Practice Address - Street 1:17340 W 12 MILE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2122
Practice Address - Country:US
Practice Address - Phone:248-346-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical