Provider Demographics
NPI:1609412246
Name:WHITAKER-CARLOS, SHENIKA LAVONDA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHENIKA
Middle Name:LAVONDA
Last Name:WHITAKER-CARLOS
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 1:6933 COMMONS PLZ # 249
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6457
Mailing Address - Country:US
Mailing Address - Phone:804-503-8487
Mailing Address - Fax:
Practice Address - Street 1:4118 E PARHAM RD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2742
Practice Address - Country:US
Practice Address - Phone:804-591-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040089311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical