MEDICARE: DR. SHENAE LASANDRA WHITEHEAD PHD, MA, LPA, LCMHCS

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	101YM0800X	Mental Health Counselor	8992	NC
2	103T00000X	Psychologist	5489	NC

General Provider Information

NPI Number	:	1609146380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHENAE LASANDRA WHITEHEAD PHD, MA, LPA, LCMHCS

Provider Business Mailing Address
First Line	:	5845 YADKIN RD UNIT D
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-2656
Country	:	US
Telephone Number	:	910-867-4417
Fax Number	:	910-302-7479

Provider Business Practice Location Address
First Line	:	5845 YADKIN RD UNIT D
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-2656
Country	:	US
Telephone Number	:	910-867-4417
Fax Number	:	910-302-7479

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	08/22/2023

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