Provider Demographics
NPI:1497132013
Name:LEMOIS, SHAIDA BLACKMON (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAIDA
Middle Name:BLACKMON
Last Name:LEMOIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHAIDA
Other - Middle Name:
Other - Last Name:BLACKMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE A100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6302
Practice Address - Country:US
Practice Address - Phone:864-454-5612
Practice Address - Fax:864-454-5121
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10808104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1754Medicaid