Provider Demographics
NPI:1043543374
Name:EVANS, SHEILA RENEE (LMSW)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:RENEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:RENEE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15734 WHITCOMB ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2667
Mailing Address - Country:US
Mailing Address - Phone:313-333-7881
Mailing Address - Fax:313-493-4415
Practice Address - Street 1:13575 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3131
Practice Address - Country:US
Practice Address - Phone:313-493-4410
Practice Address - Fax:313-493-4415
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091220104100000X, 101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801091220OtherSTATE OF MI LICENSE