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Provider Information for 1114500915


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SHANEQUA PALMER


Sex: Female

NPI: 1114500915
Last Updated: 2021-05-18
Certification Date: 2021-05-18

Details

NameValue
NPI1114500915
Enumeration Date2021-04-30
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 218 BRIGHTON PARK BLVD STE 102
SUMMERVILLE, SC 29486-3000
United States

Phone: 843-425-2116 | Fax:
 
Primary Practice Address 218 BRIGHTON PARK BLVD STE 102
SUMMERVILLE, SC 29486-3000
United States

Phone: 843-425-2116 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthSC7648