Healthcare Provider Details

I. General information

NPI: 1154063451
Provider Name (Legal Business Name): KRISHAWNA ERICA SHEARER CMHC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISHAWNA ERICA SHEARER PERKINS

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PARK CENTER DRIVE, SUITE 210 1701 PARK CENTER DRIVE, SUITE 210
ORLANDO FL
32835-3283
US

IV. Provider business mailing address

867 SHEOAH CIR
WINTER SPRINGS FL
32708-2011
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3837
  • Fax:
Mailing address:
  • Phone: 407-283-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: