Provider Demographics
NPI:1639833049
Name:MAY, SHANTESSA FAITH (MS)
Entity Type:Individual
Prefix:
First Name:SHANTESSA
Middle Name:FAITH
Last Name:MAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4016
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4016
Mailing Address - Country:US
Mailing Address - Phone:304-687-9329
Mailing Address - Fax:
Practice Address - Street 1:1021 QUARRIER ST STE 310
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2338
Practice Address - Country:US
Practice Address - Phone:304-513-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health