Provider Demographics
NPI:1699369074
Name:WYCHE, SHAMEKA (LPC)
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:
Last Name:WYCHE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SHADY LANE AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1919
Mailing Address - Country:US
Mailing Address - Phone:434-336-7837
Mailing Address - Fax:
Practice Address - Street 1:425 S MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-2300
Practice Address - Country:US
Practice Address - Phone:434-336-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional