Provider Demographics
NPI:1518592476
Name:CANTY, SHAQUITA (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:SHAQUITA
Middle Name:
Last Name:CANTY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 E CORNWALLIS RD APT B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5452
Mailing Address - Country:US
Mailing Address - Phone:984-244-0740
Mailing Address - Fax:
Practice Address - Street 1:8390 SIX FORKS RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3060
Practice Address - Country:US
Practice Address - Phone:919-890-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0130281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical