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Individual
MS. LA'DRAYA SHAMICKA MACON
Active
Individual
MS. LA'DRAYA SHAMICKA MACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CASAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
31869
NY
104100000X
Social Worker
086013
NY
1041C0700X
Clinical Social Worker
Primary
083947
NY
Other
Enumeration date
03/08/2012
Last updated
05/04/2016
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