Provider Demographics
NPI:1609146380
Name:WHITEHEAD, SHENAE LASANDRA (PHD, MA, LPA, LCMHCS)
Entity Type:Individual
Prefix:DR
First Name:SHENAE
Middle Name:LASANDRA
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PHD, MA, LPA, LCMHCS
Other - Prefix:
Other - First Name:SHENAE
Other - Middle Name:
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MA, LPA, LCMHCS
Mailing Address - Street 1:5845 YADKIN RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2656
Mailing Address - Country:US
Mailing Address - Phone:910-867-4417
Mailing Address - Fax:910-302-7479
Practice Address - Street 1:5845 YADKIN RD UNIT D
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2656
Practice Address - Country:US
Practice Address - Phone:910-867-4417
Practice Address - Fax:910-302-7479
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8992101YM0800X
NC5489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health