Healthcare Provider Details

I. General information

NPI: 1023509460
Provider Name (Legal Business Name): SHAUNTE HARRIS REGISTER SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 W CENTRAL AVE STE B1
TOLEDO OH
43615-1519
US

IV. Provider business mailing address

4429 PACKARD RD
TOLEDO OH
43612-1943
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-8006
  • Fax:
Mailing address:
  • Phone: 419-973-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberCDCA.173763
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.173763
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW.2600529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: