Provider Demographics
NPI:1902502495
Name:SHEGOG, KAREEM L (MS, MPH ALC)
Entity Type:Individual
Prefix:MR
First Name:KAREEM
Middle Name:L
Last Name:SHEGOG
Suffix:
Gender:M
Credentials:MS, MPH ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 COUNTRY CLUB LOOP
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092
Mailing Address - Country:US
Mailing Address - Phone:334-332-3028
Mailing Address - Fax:
Practice Address - Street 1:103 EAST OAK ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-7001
Practice Address - Fax:334-727-0291
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC21281A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty