Provider Demographics
NPI:1881715241
Name:MOORE, SHANIKE ANTWAN (CMSW)
Entity type:Individual
Prefix:MRS
First Name:SHANIKE
Middle Name:ANTWAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 GREENBROOK BND APT 5
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8148
Mailing Address - Country:US
Mailing Address - Phone:901-383-9792
Mailing Address - Fax:
Practice Address - Street 1:1327 GREENBROOK BND APT 5
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-8148
Practice Address - Country:US
Practice Address - Phone:901-383-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000064861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical