Healthcare Provider Details

I. General information

NPI: 1578609368
Provider Name (Legal Business Name): SHAWNTA DYNISE BRENT LSW, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWNTA DYNISE THOMAS LSW, PC

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SUMMIT RD SUITE 216
CINCINNATI OH
45237-2822
US

IV. Provider business mailing address

1490 UNIVERSITY BLVD
HAMILTON OH
45011-3305
US

V. Phone/Fax

Practice location:
  • Phone: 513-948-0023
  • Fax: 513-948-0087
Mailing address:
  • Phone: 513-896-7887
  • Fax: 513-896-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0008428
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS23628
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: