Provider Demographics
NPI:1770770158
Name:KELLY, SHEILA ANN (LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1570
Mailing Address - Country:US
Mailing Address - Phone:810-232-9950
Mailing Address - Fax:810-232-9110
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1570
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:810-232-9110
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010631151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI595693OtherVALUEOPTIONS