Provider Demographics
NPI:1790237048
Name:SHINE, LASHEKA (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:LASHEKA
Middle Name:
Last Name:SHINE
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:LASHEKA
Other - Middle Name:
Other - Last Name:DREW-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:3018 OLD MINDEN RD STE 1111A
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2476
Mailing Address - Country:US
Mailing Address - Phone:318-751-6687
Mailing Address - Fax:318-800-4448
Practice Address - Street 1:3018 OLD MINDEN RD STE 1111A
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2476
Practice Address - Country:US
Practice Address - Phone:318-751-6687
Practice Address - Fax:318-751-6687
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040137991041C0700X
LA124481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA852058844Medicaid
LA852058844OtherPRIVATE INSURANCE