Provider Demographics
NPI:1477996700
Name:LEE, SHANIKA F (PCMHT)
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:F
Last Name:LEE
Suffix:
Gender:F
Credentials:PCMHT
Other - Prefix:MISS
Other - First Name:SHANIKA
Other - Middle Name:F
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCC
Mailing Address - Street 1:P.O. BOX 1
Mailing Address - Street 2:3550 HIGHWAY, 468 WEST FISCAL SERVICES
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-0175
Mailing Address - Country:US
Mailing Address - Phone:601-351-8000
Mailing Address - Fax:
Practice Address - Street 1:3550 HIGHWAY, 468 WEST
Practice Address - Street 2:FISCAL SERVICES
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193-0157
Practice Address - Country:US
Practice Address - Phone:601-351-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health