Provider Demographics
NPI:1659061562
Name:SHELLMAN, CIARA CAPRICE I (LLMSW)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:CAPRICE
Last Name:SHELLMAN
Suffix:I
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20559 MOTOR DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1889
Mailing Address - Country:US
Mailing Address - Phone:517-528-3609
Mailing Address - Fax:
Practice Address - Street 1:7517 YELLOW WOOD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7620
Practice Address - Country:US
Practice Address - Phone:517-528-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511162801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty