Shaconya Lacole Bordeaux
Community/Behavioral Health in Council, NC. Individual provider (NPI-1).
NPI number1437742004
StatusActive
Last updated in NPPESMar 10, 2021
Details
- NPI
- 1437742004
- Entity type
- Individual (NPI-1)
- Name
- Shaconya Lacole Bordeaux
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Feb 15, 2021
- Certification date
- Mar 10, 2021
- Last updated
- Mar 10, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
54 Warren AveCouncil, NC 28434-8406
Phone 919-612-1617
Mailing address
54 Warren AveCouncil, NC 28434-8406
Phone 919-612-1617
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