Provider Demographics
NPI:1497014666
Name:SHACKELFORD-MCMILLIAN, DEONAE SHEREE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEONAE
Middle Name:SHEREE
Last Name:SHACKELFORD-MCMILLIAN
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 1:18408 HATTERAS ST UNIT 39
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1913
Mailing Address - Country:US
Mailing Address - Phone:626-200-5996
Mailing Address - Fax:
Practice Address - Street 1:18408 HATTERAS ST UNIT 39
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1913
Practice Address - Country:US
Practice Address - Phone:626-200-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1210671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program