Provider Demographics
NPI:1285308064
Name:STAKES, SHEENA L (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:L
Last Name:STAKES
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ROBLEY DR APT 11103
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5538
Mailing Address - Country:US
Mailing Address - Phone:318-664-1431
Mailing Address - Fax:337-345-8016
Practice Address - Street 1:1100 ROBLEY DR APT 11103
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5538
Practice Address - Country:US
Practice Address - Phone:318-664-1431
Practice Address - Fax:337-345-8016
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA145381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical