Provider Demographics
NPI:1649864711
Name:NATTY, SHADENA LOUISE (LPC, MA, MS, CAADC)
Entity type:Individual
Prefix:
First Name:SHADENA
Middle Name:LOUISE
Last Name:NATTY
Suffix:
Gender:F
Credentials:LPC, MA, MS, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3878
Mailing Address - Country:US
Mailing Address - Phone:717-473-7917
Mailing Address - Fax:
Practice Address - Street 1:8 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3878
Practice Address - Country:US
Practice Address - Phone:717-473-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15734101YA0400X
PAPC013516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)