Provider Information for 1720602527
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SHANNON E RAIKES M.Ed., LMHC
Sex: Female
NPI: 1720602527
Last Updated: 2020-06-08
Certification Date: 2020-06-08
Certification Date: 2020-06-08
Details
Name | Value | ||||||||
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NPI | 1720602527 | ||||||||
Enumeration Date | 2020-06-08 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 13990 BARTRAM PARK BLVD UNIT 209 JACKSONVILLE, FL 32258-5543 United States Phone: 214-551-5365 | Fax: | ||||||||
Primary Practice Address | 13990 BARTRAM PARK BLVD UNIT 209 JACKSONVILLE, FL 32258-5543 United States Phone: 214-551-5365 | Fax: | ||||||||
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