MEDICARE: MRS. REBECCA CANDACE SHELTON-WILLIAMS LMSW

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	1041C0700X	Clinical Social Worker	6801085506	MI

General Provider Information

NPI Number	:	1740428820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA CANDACE SHELTON-WILLIAMS LMSW

Provider Business Mailing Address
First Line	:	22511 TELEGRAPH RD STE 101
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-4108
Country	:	US
Telephone Number	:	248-356-0540
Fax Number	:	248-356-0539

Provider Business Practice Location Address
First Line	:	22511 TELEGRAPH RD STE 101
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-4108
Country	:	US
Telephone Number	:	248-356-0540
Fax Number	:	248-356-0539

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

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	01/28/2009

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