Provider Demographics
NPI:1932732526
Name:LYKES, SHANENA MONEQUE
Entity Type:Individual
Prefix:
First Name:SHANENA
Middle Name:MONEQUE
Last Name:LYKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 MAJORITY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-9364
Mailing Address - Country:US
Mailing Address - Phone:803-201-5092
Mailing Address - Fax:
Practice Address - Street 1:90 BRIGHTON HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7987
Practice Address - Country:US
Practice Address - Phone:803-898-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health