Provider Demographics
NPI:1144643206
Name:BLACKSHEAR, CUKEYRA (LLMSW)
Entity type:Individual
Prefix:MS
First Name:CUKEYRA
Middle Name:
Last Name:BLACKSHEAR
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 W CANFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1105
Mailing Address - Country:US
Mailing Address - Phone:313-258-5415
Mailing Address - Fax:
Practice Address - Street 1:1131 W CANFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1105
Practice Address - Country:US
Practice Address - Phone:313-258-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087949251B00000X
MI68010986201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251B00000XAgenciesCase Management