Provider Demographics
NPI:1417733064
Name:PEGUES, SHANTERRICA SHANAE' (MSW, CMHT)
Entity Type:Individual
Prefix:MS
First Name:SHANTERRICA
Middle Name:SHANAE'
Last Name:PEGUES
Suffix:
Gender:F
Credentials:MSW, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13A COUNTY ROAD 298
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38601-9107
Mailing Address - Country:US
Mailing Address - Phone:662-783-2703
Mailing Address - Fax:
Practice Address - Street 1:152 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5392
Practice Address - Country:US
Practice Address - Phone:662-234-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker