Provider Demographics
NPI:1215784277
Name:MOORE, SHANIQUA LASHAE (LCSW)
Entity type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:LASHAE
Last Name:MOORE
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 1:9321 MIDLOTHIAN TPKE STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4941
Mailing Address - Country:US
Mailing Address - Phone:804-252-4525
Mailing Address - Fax:
Practice Address - Street 1:9321 MIDLOTHIAN TPKE STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4941
Practice Address - Country:US
Practice Address - Phone:804-252-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040167431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical