Healthcare Provider Details

I. General information

NPI: 1780030312
Provider Name (Legal Business Name): SHANIKA TESTAMARK LPC, CSAC, CRP, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANIKA TESTAMARK-HARRIS LPC, CSAC, CRP, CADC

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 COMMERCE DR STE 315
HAMPTON VA
23666-4298
US

IV. Provider business mailing address

1919 COMMERCE DR STE 315
HAMPTON VA
23666-4298
US

V. Phone/Fax

Practice location:
  • Phone: 757-204-5469
  • Fax:
Mailing address:
  • Phone: 757-575-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number0715005525
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701006620
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710102608
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: