Provider Demographics
NPI:1922723709
Name:TRIMBLE, SHAWNTIEREA IRENE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAWNTIEREA
Middle Name:IRENE
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHAWNTIEREA
Other - Middle Name:IRENE
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:20857 GREENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7115
Mailing Address - Country:US
Mailing Address - Phone:313-671-0965
Mailing Address - Fax:
Practice Address - Street 1:20857 GREENVIEW RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7115
Practice Address - Country:US
Practice Address - Phone:313-671-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010826301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical