MEDICARE: MRS. LEKEISHA SHENNILLE HITE LPC, CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710102177	VA
2	101YP2500X	Professional Counselor	0701004996	VA

General Provider Information

NPI Number	:	1316244510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEKEISHA SHENNILLE HITE LPC, CSAC

Provider Business Mailing Address
First Line	:	6946 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1606
Country	:	US
Telephone Number	:	804-560-8882
Fax Number	:	804-560-8884

Provider Business Practice Location Address
First Line	:	6946 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1606
Country	:	US
Telephone Number	:	804-560-8882
Fax Number	:	804-560-8884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	02/24/2011

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