Provider Demographics
NPI:1932987872
Name:COWENS, SHAYVONNA Q
Entity Type:Individual
Prefix:
First Name:SHAYVONNA
Middle Name:Q
Last Name:COWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:Q
Other - Last Name:COWENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:829 E GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3912
Mailing Address - Country:US
Mailing Address - Phone:318-242-0730
Mailing Address - Fax:
Practice Address - Street 1:829 E GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3912
Practice Address - Country:US
Practice Address - Phone:318-242-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty