Provider Demographics
NPI:1790457315
Name:PEEPLES, SHEKENA L
Entity Type:Individual
Prefix:
First Name:SHEKENA
Middle Name:L
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 KAYMIN HILL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6709
Mailing Address - Country:US
Mailing Address - Phone:803-361-0137
Mailing Address - Fax:
Practice Address - Street 1:565 KAYMIN HILL CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6709
Practice Address - Country:US
Practice Address - Phone:803-361-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty