Provider Demographics
NPI:1144749235
Name:DRAUGHN, SHAKETA N L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAKETA
Middle Name:N L
Last Name:DRAUGHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 KINGS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7895
Mailing Address - Country:US
Mailing Address - Phone:757-921-0709
Mailing Address - Fax:
Practice Address - Street 1:2025 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7072
Practice Address - Country:US
Practice Address - Phone:804-447-0193
Practice Address - Fax:804-562-1438
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040099371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical