Provider Demographics
NPI:1942668421
Name:THOMAS, SHAQUANA R (LPC# 6671)
Entity Type:Individual
Prefix:MRS
First Name:SHAQUANA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC# 6671
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GENERAL GARDNER AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7824
Mailing Address - Country:US
Mailing Address - Phone:337-232-9457
Mailing Address - Fax:337-232-9459
Practice Address - Street 1:6315 GULFTON ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA6671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator