Provider Demographics
NPI:1891934113
Name:COLLINS-GODETTE, SHANDA NICOLE (MSW, LCAS, P-LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:NICOLE
Last Name:COLLINS-GODETTE
Suffix:
Gender:F
Credentials:MSW, LCAS, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 FISHER TOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-8964
Mailing Address - Country:US
Mailing Address - Phone:252-229-3113
Mailing Address - Fax:252-447-1986
Practice Address - Street 1:560 FISHER TOWN RD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-8964
Practice Address - Country:US
Practice Address - Phone:252-229-3113
Practice Address - Fax:252-447-1986
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1335101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)