Individual
SHANTEL WIMBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7310 WOODWARD AVE, DETROIT, MI 48202-3165
(313) 896-1444
Mailing address
7310 WOODWARD AVE, DETROIT, MI 48202-3165
(313) 204-8511
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451022064
MI
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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