Healthcare Provider Details

I. General information

NPI: 1629696125
Provider Name (Legal Business Name): SHEREKA DABNEY LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 05/19/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SUNSET RD UNIT 681556
CHARLOTTE NC
28216-0468
US

IV. Provider business mailing address

1101 SUNSET RD UNIT 681556
CHARLOTTE NC
28216-0468
US

V. Phone/Fax

Practice location:
  • Phone: 980-495-6305
  • Fax: 980-495-6535
Mailing address:
  • Phone: 980-495-6305
  • Fax: 980-495-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberP014800
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014800
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: