Provider Demographics
NPI:1194325688
Name:ROWAN-BENNETT, SHANIQUA JULYLAH (MS, LPC)
Entity type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:JULYLAH
Last Name:ROWAN-BENNETT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:S.
Other - Middle Name:JULYLAH
Other - Last Name:ROWAN-BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:8329 W MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3303 S LINDSAY RD STE 108
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1504
Practice Address - Country:US
Practice Address - Phone:480-339-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19367101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health