Active NPI
Shadorie Anne James, CCMA
- Clinical Social Worker
- Detroit, MI
National Provider Identifier
1023553385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 6309 Mack Ave
Detroit, MI 48207-2302 - Phone
- (313) 282-8447
- NPI assigned
- Dec 22, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary | ||
| Prevention Professional | 405300000X | Z5H7G8R8 | MI |
Addresses
Primary practice location
6309 Mack Ave
Detroit, MI 48207-2302
Mailing address
6309 Mack Ave
Detroit, MI 48207-2302
Phone (313) 282-8447
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Z5H7G8R8 | MI | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718841600000",
"number": "1023553385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6309 MACK AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482072302",
"telephone_number": "313-282-8447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6309 MACK AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482072302",
"telephone_number": "313-282-8447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAMES",
"first_name": "SHADORIE",
"middle_name": "ANNE",
"credential": "CCMA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-22",
"last_updated": "2024-06-20",
"certification_date": "2024-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
},
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "MI",
"license": "Z5H7G8R8",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.