Provider Demographics
NPI:1629808787
Name:MENSO, SHANITA S (NCC, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:SHANITA
Middle Name:S
Last Name:MENSO
Suffix:
Gender:F
Credentials:NCC, LMHC, LPC
Other - Prefix:
Other - First Name:SHANITA
Other - Middle Name:S
Other - Last Name:COOPER-PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1065 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3022
Mailing Address - Country:US
Mailing Address - Phone:267-999-9155
Mailing Address - Fax:
Practice Address - Street 1:1065 S MADISON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3022
Practice Address - Country:US
Practice Address - Phone:267-999-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional