Provider Demographics
NPI:1831736305
Name:SHAKOFSKY, KEELIN HUNTER (BCBA)
Entity type:Individual
Prefix:
First Name:KEELIN
Middle Name:HUNTER
Last Name:SHAKOFSKY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KEELIN
Other - Middle Name:ALANA
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:421 FAYETTEVILLE ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:633 N ONEIL ST APT 101
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-1897
Practice Address - Country:US
Practice Address - Phone:984-363-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician