Active NPI
Shanita Denise Eccles
- Clinical Social Worker
- Lincoln Park, MI
National Provider Identifier
1356707855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801106111
- Practice address
- 26300 Outer Dr
Lincoln Park, MI 48146-2019 - Phone
- (734) 785-7700
- NPI assigned
- Jan 13, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C013951 | NC | |
| Clinical Social Worker | 1041C0700X | SWB-2022-1012 | NM | |
| Clinical Social Worker | 1041C0700X | 6801106111 | MI | Primary |
Addresses
Primary practice location
26300 Outer Dr
Lincoln Park, MI 48146-2019
Mailing address
33416 Sand Piper Dr
Romulus, MI 48174-6404
Phone (734) 502-4848
Other practice location 1
3901 Beaubien St
Detroit, MI 48201-2119
Phone (313) 745-5281
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SWB-2022-1012 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Guidance Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Southgate, MI
- NPI 1609947027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732060800000",
"number": "1356707855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33416 SAND PIPER DR",
"city": "ROMULUS",
"state": "MI",
"postal_code": "481746404",
"telephone_number": "734-502-4848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26300 OUTER DR",
"city": "LINCOLN PARK",
"state": "MI",
"postal_code": "481462019",
"telephone_number": "734-785-7700"
}
],
"practiceLocations": [
{
"address_1": "3901 Beaubien St",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482012119",
"country_code": "US",
"telephone_number": "313-745-5281",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ECCLES",
"first_name": "SHANITA",
"middle_name": "DENISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-13",
"last_updated": "2024-11-20",
"certification_date": "2024-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C013951",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "SWB-2022-1012",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801106111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.