MEDICARE: SHELITA D RICHMOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	6401224730	MI
2	101YM0800X	Mental Health Counselor	6401224730	MI

General Provider Information

NPI Number	:	1265608624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELITA D RICHMOND

Provider Business Mailing Address
First Line	:	18875 ROGGE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3088
Country	:	US
Telephone Number	:	313-717-1761
Fax Number	:

Provider Business Practice Location Address
First Line	:	18875 ROGGE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3088
Country	:	US
Telephone Number	:	313-717-1761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	12/05/2025

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Directions to “ SHELITA D RICHMOND ” Practice Location

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