Provider Demographics
NPI:1093847790
Name:ALLISON, SHAMEIKA DANIELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHAMEIKA
Middle Name:DANIELLE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAMEIKA
Other - Middle Name:DANIELLE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6262
Mailing Address - Country:US
Mailing Address - Phone:770-401-8053
Mailing Address - Fax:
Practice Address - Street 1:990 VILLA ST MOUNTAIN VIEW
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041
Practice Address - Country:US
Practice Address - Phone:770-401-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW20028101YM0800X
GA0042301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01605808Medicare UPIN