Provider Demographics
NPI:1578609368
Name:BRENT, SHAWNTA DYNISE (LSW, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNTA
Middle Name:DYNISE
Last Name:BRENT
Suffix:
Gender:F
Credentials:LSW, LPCC
Other - Prefix:MS
Other - First Name:SHAWNTA
Other - Middle Name:DYNISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, PC
Mailing Address - Street 1:1490 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3305
Mailing Address - Country:US
Mailing Address - Phone:513-896-7887
Mailing Address - Fax:513-896-5682
Practice Address - Street 1:1821 SUMMIT RD
Practice Address - Street 2:SUITE 216
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2822
Practice Address - Country:US
Practice Address - Phone:513-948-0023
Practice Address - Fax:513-948-0087
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS23628104100000X
OHE0008428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker