Provider Demographics
NPI:1922296946
Name:KILLEN, SHARON ANGELL (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANGELL
Last Name:KILLEN
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 1:6589 SCENIC PINES CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4475
Mailing Address - Country:US
Mailing Address - Phone:947-247-6289
Mailing Address - Fax:
Practice Address - Street 1:6589 SCENIC PINES CT
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4475
Practice Address - Country:US
Practice Address - Phone:947-247-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085884104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker