Provider Demographics
NPI:1144977604
Name:GARNER, SHONDETTE RENA (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:SHONDETTE
Middle Name:RENA
Last Name:GARNER
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 N SABINE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2450
Mailing Address - Country:US
Mailing Address - Phone:225-931-7424
Mailing Address - Fax:
Practice Address - Street 1:1143 N SABINE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2450
Practice Address - Country:US
Practice Address - Phone:225-931-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
101YM0800X, 101Y00000X, 171M00000X
LAPLC9013101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator