Provider Demographics
NPI:1518439272
Name:WESLEY, SHANIQUA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:
Last Name:WESLEY
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 1:615 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-4825
Mailing Address - Country:US
Mailing Address - Phone:504-330-6695
Mailing Address - Fax:
Practice Address - Street 1:1919 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4003
Practice Address - Country:US
Practice Address - Phone:504-330-6695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X, 171M00000X
LA13675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator