Provider Demographics
NPI:1639466253
Name:HARRISON, SHANEEKA S (LAC)
Entity Type:Individual
Prefix:
First Name:SHANEEKA
Middle Name:S
Last Name:HARRISON
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 1:2401 POINTMERE DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2152
Mailing Address - Country:US
Mailing Address - Phone:504-650-2297
Mailing Address - Fax:
Practice Address - Street 1:2401 POINTMERE DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2152
Practice Address - Country:US
Practice Address - Phone:504-650-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)