Provider Demographics
NPI:1669763629
Name:SMITH, SHANEIKA (PHD, LPC-MHSP)
Entity type:Individual
Prefix:DR
First Name:SHANEIKA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 BIRD STONE COVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:901-756-1510
Mailing Address - Fax:
Practice Address - Street 1:10640 BIRD STONE CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5561
Practice Address - Country:US
Practice Address - Phone:901-800-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN000562213101YS0200X
TN5350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool