Healthcare Provider Details

I. General information

NPI: 1609224021
Provider Name (Legal Business Name): SHANIQUA JOHNSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W LEA BLVD STE 202
WILMINGTON DE
19802-2545
US

IV. Provider business mailing address

215 W GENERAL GREY CT
NEWARK DE
19702-3829
US

V. Phone/Fax

Practice location:
  • Phone: 302-204-7740
  • Fax:
Mailing address:
  • Phone: 215-214-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001615
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: