Provider Demographics
NPI:1225383102
Name:LESESNE, SHANIQUA (LISW-CP, EDD)
Entity type:Individual
Prefix:DR
First Name:SHANIQUA
Middle Name:
Last Name:LESESNE
Suffix:
Gender:F
Credentials:LISW-CP, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 SALTCEDAR LN
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-7543
Mailing Address - Country:US
Mailing Address - Phone:803-460-6694
Mailing Address - Fax:
Practice Address - Street 1:15 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4224
Practice Address - Country:US
Practice Address - Phone:803-902-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health