Individual
SHEA WITHERSPOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
10209 W CENTRAL AVE, WICHITA, KS 67212-4684
(316) 204-0369
Mailing address
2140 E CHARLESTON DR, PARK CITY, KS 67219-1702
(316) 204-0369
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
00935
KS
104100000X
Social Worker
Primary
0700
KS
104100000X
Social Worker
Primary
12623
KS
1041C0700X
Clinical Social Worker
Primary
0700
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00935
LCAC
KS
Enumeration date
07/13/2022
Last updated
03/12/2026
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