Healthcare Provider Details

I. General information

NPI: 1316549504
Provider Name (Legal Business Name): SHAMIEKA HEYWARD MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 REAGAN DR STE 14
CHARLOTTE NC
28206-1395
US

IV. Provider business mailing address

6543 MATLEA CT
CHARLOTTE NC
28215-5011
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-8787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014595
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: