Provider Demographics
NPI:1114669843
Name:HULLOM, SHEMIKA (P-LPC)
Entity Type:Individual
Prefix:
First Name:SHEMIKA
Middle Name:
Last Name:HULLOM
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 N POLE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4609
Mailing Address - Country:US
Mailing Address - Phone:901-859-2433
Mailing Address - Fax:
Practice Address - Street 1:8116 N POLE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4609
Practice Address - Country:US
Practice Address - Phone:901-859-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional