Healthcare Provider Details

I. General information

NPI: 1346786274
Provider Name (Legal Business Name): SHENA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

7420 DORAL DR
YPSILANTI MI
48197-9565
US

V. Phone/Fax

Practice location:
  • Phone: 313-210-4713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801100533
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: