Shenita Paulette Mangum, LCSWA, LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C010188 Issued in NC

Practice address

355 S Madison Blvd
Suite C1
Roxboro, NC 27573-5485

Phone

(336) 599-8366

NPI assigned

Jul 20, 2015

Last updated

Jul 29, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Freedom House Recovery Center, Inc.

  • Community/Behavioral Health Agency
  • Roxboro, NC
  • NPI 1093986523
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469750400000",
    "number": "1972987972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 S MADISON BLVD",
            "address_2": "SUITE C1",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735485",
            "telephone_number": "336-599-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 S MADISON BLVD",
            "address_2": "SUITE C1",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735485",
            "telephone_number": "336-599-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "SHENITA",
        "middle_name": "PAULETTE",
        "credential": "LCSWA, LCASA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2016-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C010188",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-20628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Eileen Luna, OTR
• Maureen Frances Lynch, AGNP-C
• Kaitlyn Kirby Lytle, PA-C
• Peter W. Majka Jr., PAC
• Dedric Marvin Mangum
• Mankind LLC (Maple height assisted living)
• Marlab,Inc
• Crystal Lynn Martin, AGNP-BC
• Mary Rowe FCH
• Mary Rowe FCH #2

• Clinical Social Worker in Roxboro, NC
• Providers in Roxboro, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.