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General NPI Number Information
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NPI Number | 1073992400
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Entity Type | Individual
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Provider Name | SHAKEIA NIAISHA BOND LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 8801 J M KEYNES DR SUITE 440
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City | CHARLOTTE
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State | NC
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Zip | 28262-8436
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Country | US
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Telephone | 704-537-9551
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Fax | 704-207-4845
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | COLERAIN
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State | NC
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Zip | 27924-0103
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Country | US
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Telephone | 980-613-8552
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P009457
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License Number State | NC
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