Shaconya Lacole Bordeaux
Individual provider Active NPI Community/Behavioral Health Agency · Council, NC
NPI 1437742004 · NPPES record last updated Mar 10, 2021
Key facts
- NPI
- 1437742004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Practice address
- 54 Warren Ave
Council, NC 28434-8406 - Phone
- (919) 612-1617
- NPI assigned
- Feb 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
54 Warren Ave
Council, NC 28434-8406
Mailing address
54 Warren Ave
Council, NC 28434-8406
Phone (919) 612-1617
Other providers in Council, NC
All providers in Council, NC · Community/Behavioral Health Agency in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.