Provider Demographics
NPI:1093367229
Name:PRICE, SHAKEITA (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAKEITA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CHATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6664
Mailing Address - Country:US
Mailing Address - Phone:843-617-3790
Mailing Address - Fax:
Practice Address - Street 1:1800 2ND LOOP RD STE 3
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6180
Practice Address - Country:US
Practice Address - Phone:843-667-1905
Practice Address - Fax:843-667-1723
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker