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General NPI Number Information
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NPI Number | 1780030312
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Entity Type | Individual
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Provider Name | SHANIKA TESTAMARK LPC, CSAC, CRP, CADC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1919 COMMERCE DR STE 315
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City | HAMPTON
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State | VA
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Zip | 23666-4298
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Country | US
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Telephone | 757-204-5469
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 COMMERCE DR STE 315
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City | HAMPTON
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State | VA
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Zip | 23666-4298
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Country | US
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Telephone | 757-575-5535
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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 | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 0715005525
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701006620
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102608
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License Number State | VA
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