Provider Demographics
NPI:1952735169
Name:SPELLER, SHAKEENA YVETTE (LCSW, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:SHAKEENA
Middle Name:YVETTE
Last Name:SPELLER
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:MS
Other - First Name:SHAKEENA
Other - Middle Name:YVETTE
Other - Last Name:RISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 N CANNON BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3798
Mailing Address - Country:US
Mailing Address - Phone:980-206-3722
Mailing Address - Fax:704-731-7178
Practice Address - Street 1:700 N CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3798
Practice Address - Country:US
Practice Address - Phone:980-206-3722
Practice Address - Fax:704-731-7178
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2595101YA0400X
NCC0100031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE