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NPI Code Detail

MEDICARE: SHANIQUA CELESS BURNETTE MS,LCMHC, LCASA, NCC

MEDICARE: SHANIQUA CELESS BURNETTE MS,LCMHC, LCASA, NCC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCASA25077NC
2101YM0800XMental Health CounselorA14443NC
3101YP2500XProfessional Counselor14443NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740750249
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANIQUA CELESS BURNETTE MS,LCMHC, LCASA, NCC
Provider Business Mailing Address
First Line : 3705 LATROBE DR STE 340
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-4823
Country : US
Telephone Number : 704-364-3989
Fax Number :
Provider Business Practice Location Address
First Line : 3705 LATROBE DR STE 340
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-4823
Country : US
Telephone Number : 704-364-3989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2018
Last Update Date : 05/08/2023

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