Provider Demographics
NPI:1740813047
Name:AHMAD, SHAYNE JERVEY (LPCMH)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:JERVEY
Last Name:AHMAD
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:SHAYNE
Other - Middle Name:NICOLE
Other - Last Name:JERVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:292 CARTER DR STE AANDB
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5846
Mailing Address - Country:US
Mailing Address - Phone:302-257-5849
Mailing Address - Fax:302-397-2068
Practice Address - Street 1:292 CARTER DR STE AANDB
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5846
Practice Address - Country:US
Practice Address - Phone:302-257-5849
Practice Address - Fax:302-397-2068
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional