Provider Demographics
NPI:1184473316
Name:SIMMONS, SHAINA MARIE (LCMSW)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 TRAILWAY CT
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-4003
Mailing Address - Country:US
Mailing Address - Phone:517-281-6716
Mailing Address - Fax:
Practice Address - Street 1:2106 TRAILWAY CT
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-4003
Practice Address - Country:US
Practice Address - Phone:517-281-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011164221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical