Provider Demographics
NPI:1538873138
Name:CEPHAS, SHANI KAMEKA (BA, CWCM)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:KAMEKA
Last Name:CEPHAS
Suffix:
Gender:F
Credentials:BA, CWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-5462
Mailing Address - Country:US
Mailing Address - Phone:804-665-4488
Mailing Address - Fax:
Practice Address - Street 1:1581 W 10TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-5462
Practice Address - Country:US
Practice Address - Phone:804-665-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health