Provider Demographics
NPI:1255221339
Name:MELYNDA SHAVONNE & CO LLC
Entity type:Organization
Organization Name:MELYNDA SHAVONNE & CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELYNDA
Authorized Official - Middle Name:SHAVONNE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-461-8601
Mailing Address - Street 1:16705 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3304
Mailing Address - Country:US
Mailing Address - Phone:313-461-8601
Mailing Address - Fax:
Practice Address - Street 1:16705 PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3304
Practice Address - Country:US
Practice Address - Phone:313-461-8601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty