Provider Demographics
NPI:1356123921
Name:FLETCHER, SHUANA FANEASE (LCSW, MAC)
Entity type:Individual
Prefix:MS
First Name:SHUANA
Middle Name:FANEASE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0423
Mailing Address - Country:US
Mailing Address - Phone:601-919-2079
Mailing Address - Fax:
Practice Address - Street 1:135 BOUNDS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4121
Practice Address - Country:US
Practice Address - Phone:601-918-2079
Practice Address - Fax:601-510-9892
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC107261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical