Healthcare Provider Details

I. General information

NPI: 1700403466
Provider Name (Legal Business Name): SHAWNAE DIKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY RD
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

501 BILLINGSLEY RD
CHARLOTTE NC
28211-1009
US

V. Phone/Fax

Practice location:
  • Phone: 704-444-2400
  • Fax:
Mailing address:
  • Phone: 704-444-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18546
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009354
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: