Provider Demographics
NPI:1609418870
Name:SHAVON MARIAH SOCIAL SERVICES, PA
Entity type:Organization
Organization Name:SHAVON MARIAH SOCIAL SERVICES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:MARIAH
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, HS-BCP,CAMS II
Authorized Official - Phone:737-781-3028
Mailing Address - Street 1:PO BOX 12365
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78711-2365
Mailing Address - Country:US
Mailing Address - Phone:737-781-3028
Mailing Address - Fax:
Practice Address - Street 1:75 CHAMPIONS LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1281
Practice Address - Country:US
Practice Address - Phone:737-781-3028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty