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General NPI Number Information
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NPI Number | 1063859510
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Entity Type | Individual
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Provider Name | SHENIQUA DONES-WALLACE LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 2500 HOLLYWOOD BLVD STE 104
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6615
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Country | US
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Telephone | 786-353-4622
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Fax | 954-944-5937
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Provider Business Mailing Address
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Address Line | 1030 NW 178TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4173
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Country | US
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Telephone | 786-213-5848
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Fax | 954-944-5937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH10688
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13004
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License Number State | FL
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