Provider Demographics
NPI:1508429051
Name:TOMS, SHANIKA M (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:M
Last Name:TOMS
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 1:17505 N 79TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8727
Mailing Address - Country:US
Mailing Address - Phone:623-850-5400
Mailing Address - Fax:623-321-7850
Practice Address - Street 1:17505 N 79TH AVE STE 111D
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8724
Practice Address - Country:US
Practice Address - Phone:623-850-5400
Practice Address - Fax:623-321-7850
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-177181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical