Healthcare Provider Details

I. General information

NPI: 1689629966
Provider Name (Legal Business Name): SHEILA LEE WASUNG M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33045 HAMILTON CT SUITE W-300
FARMINGTON HILLS MI
48334-3385
US

IV. Provider business mailing address

33045 HAMILTON CT SUITE W-300
FARMINGTON HILLS MI
48334-3385
US

V. Phone/Fax

Practice location:
  • Phone: 248-848-1558
  • Fax: 248-848-3592
Mailing address:
  • Phone: 248-848-1558
  • Fax: 248-848-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: