MEDICARE: MRS. SHAKEENA YVETTE SPELLER LCSW, LCAS

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	2595	NC
2	1041C0700X	Clinical Social Worker	C010003	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1952735169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAKEENA YVETTE SPELLER LCSW, LCAS

Provider Business Mailing Address
First Line	:	700 N CANNON BLVD STE 106
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3798
Country	:	US
Telephone Number	:	980-206-3722
Fax Number	:	704-731-7178

Provider Business Practice Location Address
First Line	:	700 N CANNON BLVD
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3798
Country	:	US
Telephone Number	:	980-206-3722
Fax Number	:	704-731-7178

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

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	09/29/2022

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