Healthcare Provider Details

I. General information

NPI: 1255256178
Provider Name (Legal Business Name): DON'NIKA LEANNA MOULDEN LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 SUPERIOR RD
TAYLOR MI
48180-5362
US

IV. Provider business mailing address

20400 SUPERIOR RD
TAYLOR MI
48180-5362
US

V. Phone/Fax

Practice location:
  • Phone: 734-282-7171
  • Fax: 734-282-7105
Mailing address:
  • Phone: 734-282-7171
  • Fax: 734-282-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802092865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: