Provider Demographics
NPI:1689629966
Name:WASUNG, SHEILA LEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:LEE
Last Name:WASUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33045 HAMILTON CT
Mailing Address - Street 2:SUITE W-300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3385
Mailing Address - Country:US
Mailing Address - Phone:248-848-1558
Mailing Address - Fax:248-848-3592
Practice Address - Street 1:33045 HAMILTON CT
Practice Address - Street 2:SUITE W-300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3385
Practice Address - Country:US
Practice Address - Phone:248-848-1558
Practice Address - Fax:248-848-3592
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI0696851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP12140006Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER