Provider Demographics
NPI:1447833439
Name:CLAY, SHANEKA LATRINA (SUD COUNSELOR)
Entity type:Individual
Prefix:
First Name:SHANEKA
Middle Name:LATRINA
Last Name:CLAY
Suffix:
Gender:F
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 PORTER ST APT C
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-8175
Mailing Address - Country:US
Mailing Address - Phone:707-209-9374
Mailing Address - Fax:
Practice Address - Street 1:2100 NAPA VALLEJO HWY BLDG 253M1M2
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-255-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11669101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)