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Individual
MISS SHANNON M MULLETT
Active
Individual
MISS SHANNON M MULLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, CAADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C-03118
MI
104100000X
Social Worker
6801090829
MI
1041C0700X
Clinical Social Worker
Primary
6801090829
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D16159
MEDICARE GROUP #
MI
01
—
38 2831313
TAX ID #
MI
Enumeration date
12/13/2010
Last updated
12/19/2016
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