Provider Demographics
NPI:1821663436
Name:DANTZLER, SHANAYA NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANAYA
Middle Name:NICOLE
Last Name:DANTZLER
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 1:2449 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1475
Mailing Address - Country:US
Mailing Address - Phone:267-346-5088
Mailing Address - Fax:
Practice Address - Street 1:2449 GOLF RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1475
Practice Address - Country:US
Practice Address - Phone:267-685-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional