Provider Demographics
NPI:1629741848
Name:MERCER, SHAQUANA (LMHP-R)
Entity Type:Individual
Prefix:MS
First Name:SHAQUANA
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 N OHENRY BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3967
Mailing Address - Country:US
Mailing Address - Phone:910-471-1489
Mailing Address - Fax:
Practice Address - Street 1:3423 N OHENRY BLVD APT C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3967
Practice Address - Country:US
Practice Address - Phone:910-471-1489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014202101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program