Provider Demographics
NPI:1730287897
Name:SHUMAKE, VICKI (LMSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:SHUMAKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 BROWN ST
Mailing Address - Street 2:#104
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4759
Mailing Address - Country:US
Mailing Address - Phone:214-394-3122
Mailing Address - Fax:214-521-1155
Practice Address - Street 1:3515 BROWN ST
Practice Address - Street 2:#104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4759
Practice Address - Country:US
Practice Address - Phone:214-394-3122
Practice Address - Fax:214-521-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical