Healthcare Provider Details

I. General information

NPI: 1548752082
Provider Name (Legal Business Name): SHAQUANTA P REESE-MITCHELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

IV. Provider business mailing address

455 STUBBS MCCORMICK RD
MONROE LA
71203-9411
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-0945
  • Fax:
Mailing address:
  • Phone: 318-450-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8072
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: