Healthcare Provider Details

I. General information

NPI: 1023514726
Provider Name (Legal Business Name): DASHA SHCHUKINA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34841 VETERANS PLAZA
WAYNE MI
48184-1733
US

IV. Provider business mailing address

3842 PAT ST
YPSILANTI MI
48197-9003
US

V. Phone/Fax

Practice location:
  • Phone: 313-292-7640
  • Fax:
Mailing address:
  • Phone: 734-985-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115289
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: