Provider Demographics
NPI:1225710817
Name:WINSTON, SHATARA (ASW)
Entity Type:Individual
Prefix:
First Name:SHATARA
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MRS
Other - First Name:SHATARA
Other - Middle Name:
Other - Last Name:VINSON WINSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASW
Mailing Address - Street 1:3418 HACKAMORE DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5717
Mailing Address - Country:US
Mailing Address - Phone:415-424-9255
Mailing Address - Fax:
Practice Address - Street 1:3418 HACKAMORE DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5717
Practice Address - Country:US
Practice Address - Phone:415-424-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health