Healthcare Provider Details

I. General information

NPI: 1073972139
Provider Name (Legal Business Name): SHAMIKA VARNADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N MORRISON BLVD STE 105&106
HAMMOND LA
70401-2242
US

IV. Provider business mailing address

1320 N MORRISON BLVD STE 105&106
HAMMOND LA
70401-2242
US

V. Phone/Fax

Practice location:
  • Phone: 985-551-5155
  • Fax: 985-551-5222
Mailing address:
  • Phone: 985-551-5155
  • Fax: 985-551-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number800735847
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: