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General NPI Number Information
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NPI Number | 1154070027
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Entity Type | Organization
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Legal Business Name | SHAW-DRAVES PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 29501 GREENFIELD RD STE 138
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2250
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Country | US
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Telephone | 248-207-1499
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Fax | 248-856-2783
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Provider Business Mailing Address
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Address Line | 2287 FRANKLIN RD
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City | BERKLEY
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State | MI
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Zip | 48072-3302
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Country | US
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Telephone | 248-209-7149
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Fax | 248-856-2783
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Authorized Official
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Title or Position | LIMITED LICENSE PSYCHOLOGIST
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Name | MS. ELIZABETH SUZANNE SHAW-DRAVES
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Credential | M.A., LLP
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Telephone | 248-207-1499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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