Provider Demographics
NPI:1578936985
Name:VALLARE, SHANDRIEKA POREE
Entity Type:Individual
Prefix:
First Name:SHANDRIEKA
Middle Name:POREE
Last Name:VALLARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20619 FLINTOFF LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0403
Mailing Address - Country:US
Mailing Address - Phone:504-722-6796
Mailing Address - Fax:
Practice Address - Street 1:2626 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6400
Practice Address - Country:US
Practice Address - Phone:504-525-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13313104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker