Provider Demographics
NPI:1629696125
Name:DABNEY, SHEREKA (LCSWA)
Entity Type:Individual
Prefix:
First Name:SHEREKA
Middle Name:
Last Name:DABNEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SUNSET RD UNIT 681556
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0468
Mailing Address - Country:US
Mailing Address - Phone:980-495-6305
Mailing Address - Fax:980-495-6535
Practice Address - Street 1:1101 SUNSET RD UNIT 681556
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0468
Practice Address - Country:US
Practice Address - Phone:980-495-6305
Practice Address - Fax:980-495-6535
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP014800405300000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629696125Medicaid