Provider Demographics
NPI:1710596804
Name:MILES, SHANIQUA (LCSW)
Entity type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13934 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827-2018
Mailing Address - Country:US
Mailing Address - Phone:773-691-5306
Mailing Address - Fax:
Practice Address - Street 1:19500 ST HWY 249 STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3027
Practice Address - Country:US
Practice Address - Phone:844-824-8775
Practice Address - Fax:281-648-2200
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX1067341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical