Provider Demographics
NPI:1457748758
Name:RILEY, SHELANA KENYELLE (LLBSW)
Entity Type:Individual
Prefix:
First Name:SHELANA
Middle Name:KENYELLE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20724 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5313
Mailing Address - Country:US
Mailing Address - Phone:734-759-0510
Mailing Address - Fax:734-324-3134
Practice Address - Street 1:20724 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5313
Practice Address - Country:US
Practice Address - Phone:734-759-0510
Practice Address - Fax:734-324-3134
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)