Provider Demographics
NPI:1942775622
Name:THOMAS, SHENEQUA RENEE (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:SHENEQUA
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 LOROPETALUM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7880
Mailing Address - Country:US
Mailing Address - Phone:704-299-2952
Mailing Address - Fax:
Practice Address - Street 1:1509 LOROPETALUM RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7880
Practice Address - Country:US
Practice Address - Phone:704-299-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional