Healthcare Provider Details

I. General information

NPI: 1851896799
Provider Name (Legal Business Name): SHAMIKA LASHON BEAVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W HOSPITALITY LN STE 11
SAN BERNARDINO CA
92408-3322
US

IV. Provider business mailing address

837 E ARROW HWY
POMONA CA
91767-2587
US

V. Phone/Fax

Practice location:
  • Phone: 323-245-6806
  • Fax:
Mailing address:
  • Phone: 909-621-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: