Basic Information
| Provider Information | |||||||||
| NPI: | 1285063834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWBERRY | ||||||||
| FirstName: | SHAWNDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13213 E 14 MILE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483126302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869394374 | ||||||||
| FaxNumber: | 5869394374 | ||||||||
| Practice Location | |||||||||
| Address1: | 13335 15 MILE RD | ||||||||
| Address2: | STE 137 | ||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483124210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5868047833 | ||||||||
| FaxNumber: | 5863001449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801095566 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 6801095566 | MI | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.