Provider Demographics
NPI:1821455130
Name:HENRY, SHAQUWANDA (LCSW)
Entity type:Individual
Prefix:
First Name:SHAQUWANDA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAQUWANDA
Other - Middle Name:
Other - Last Name:CHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1010 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2308
Mailing Address - Country:US
Mailing Address - Phone:337-232-9457
Mailing Address - Fax:
Practice Address - Street 1:1010 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2308
Practice Address - Country:US
Practice Address - Phone:337-232-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA13076104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker