Provider Demographics
NPI:1528132230
Name:PRASAD, SHOBHA (MA LLP CSW CACI LPC)
Entity type:Individual
Prefix:MRS
First Name:SHOBHA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:MA LLP CSW CACI LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 EDINBOROUGH
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4026
Mailing Address - Country:US
Mailing Address - Phone:248-851-5979
Mailing Address - Fax:248-335-4680
Practice Address - Street 1:43368 WOODWARD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0569
Practice Address - Country:US
Practice Address - Phone:248-335-1130
Practice Address - Fax:248-335-4680
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI102491101YA0400X
MI6401001407101YP2500X
MI6301007851103TC0700X
MI68010602881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical