Provider Demographics
NPI:1174309660
Name:SHEARIN, LAKISHA MARIE
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:MARIE
Last Name:SHEARIN
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 1:204 PLOTT HOUND LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8360
Mailing Address - Country:US
Mailing Address - Phone:919-671-1652
Mailing Address - Fax:
Practice Address - Street 1:204 PLOTT HOUND LN
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8360
Practice Address - Country:US
Practice Address - Phone:919-671-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical