Provider Demographics
NPI:1841679412
Name:MCCOY-CHARLES, SHENESA ENET (RADT-1)
Entity type:Individual
Prefix:MRS
First Name:SHENESA
Middle Name:ENET
Last Name:MCCOY-CHARLES
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 MILLER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1332
Mailing Address - Country:US
Mailing Address - Phone:916-451-9312
Mailing Address - Fax:916-451-4018
Practice Address - Street 1:4049 MILLER WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-451-9312
Practice Address - Fax:916-451-4018
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)