Provider Demographics
NPI:1740375427
Name:SHANK, SONDA HAWLEY (LCSW)
Entity type:Individual
Prefix:
First Name:SONDA
Middle Name:HAWLEY
Last Name:SHANK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SONDA
Other - Middle Name:L
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13575 58TH ST N
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3740
Mailing Address - Country:US
Mailing Address - Phone:800-632-6074
Mailing Address - Fax:
Practice Address - Street 1:3125 POPLARWOOD CT
Practice Address - Street 2:THE ASPEN BLDG STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1084
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7509
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0018111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106545Medicaid
NCP00106580OtherRR MEDICARE # - PARADIGM
NC6106545Medicaid