Healthcare Provider Details

I. General information

NPI: 1700619616
Provider Name (Legal Business Name): SHANISE WEATHERBEE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WASHINGTON LN STE 6A
WYNCOTE PA
19095-1400
US

IV. Provider business mailing address

25 WASHINGTON LN STE 6A
WYNCOTE PA
19095-1400
US

V. Phone/Fax

Practice location:
  • Phone: 215-586-3782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC016454
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: