Provider Demographics
NPI:1780030312
Name:TESTAMARK, SHANIKA (LPC, CSAC, CRP, CADC)
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:
Last Name:TESTAMARK
Suffix:
Gender:F
Credentials:LPC, CSAC, CRP, CADC
Other - Prefix:
Other - First Name:SHANIKA
Other - Middle Name:
Other - Last Name:TESTAMARK-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CSAC, CRP, CADC
Mailing Address - Street 1:721 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3539
Mailing Address - Country:US
Mailing Address - Phone:757-575-5535
Mailing Address - Fax:
Practice Address - Street 1:1702 TODDS LN STE 325
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3209
Practice Address - Country:US
Practice Address - Phone:757-575-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006620101Y00000X
VA0715005525225C00000X
VA0710102608101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)