Provider Demographics
NPI:1881178135
Name:CARODINE, SHAKEA (LMSW)
Entity type:Individual
Prefix:
First Name:SHAKEA
Middle Name:
Last Name:CARODINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N 18TH ST STE 217
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4419
Mailing Address - Country:US
Mailing Address - Phone:318-600-6838
Mailing Address - Fax:318-600-6837
Practice Address - Street 1:1900 N 18TH ST STE 217
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4419
Practice Address - Country:US
Practice Address - Phone:318-600-6838
Practice Address - Fax:318-600-6837
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14674104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAXUQ202374007OtherPRIVATE INSURANCE