Provider Demographics
NPI:1194505636
Name:HAGGINS-JACKSON, SHENEEK LLOYETTE (MSW, MS, LBSW,)
Entity type:Individual
Prefix:MRS
First Name:SHENEEK
Middle Name:LLOYETTE
Last Name:HAGGINS-JACKSON
Suffix:
Gender:F
Credentials:MSW, MS, LBSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S WILLOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2693
Mailing Address - Country:US
Mailing Address - Phone:803-235-9204
Mailing Address - Fax:
Practice Address - Street 1:102 S WILLOW LAKE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2693
Practice Address - Country:US
Practice Address - Phone:803-235-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP019807101Y00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor