Healthcare Provider Details

I. General information

NPI: 1750100285
Provider Name (Legal Business Name): MRS. DANIELLE CHIVAEN REEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17320 W 12 MILE RD STE 101
SOUTHFIELD MI
48076-2102
US

IV. Provider business mailing address

14296 SHAMROCK DR
REDFORD MI
48239-2994
US

V. Phone/Fax

Practice location:
  • Phone: 248-727-3456
  • Fax:
Mailing address:
  • Phone: 313-850-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: