Provider Demographics
NPI:1619609906
Name:WEAR, SHAWNDA ELAINE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNDA
Middle Name:ELAINE
Last Name:WEAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 MABLE NELL RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2964
Mailing Address - Country:US
Mailing Address - Phone:479-806-3237
Mailing Address - Fax:
Practice Address - Street 1:2408 S 51ST CT STE G
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3666
Practice Address - Country:US
Practice Address - Phone:479-323-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2206015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health