Provider Demographics
NPI:1609409994
Name:SHILLING, JOSHUA J (LLMSW, CCS, CAADC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:SHILLING
Suffix:
Gender:M
Credentials:LLMSW, CCS, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 S SAGINAW ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8126
Mailing Address - Country:US
Mailing Address - Phone:947-225-7654
Mailing Address - Fax:
Practice Address - Street 1:10801 S SAGINAW ST STE D
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8126
Practice Address - Country:US
Practice Address - Phone:810-771-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
175T00000X
MI6851117368104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist