# SELF MENTAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356247761
- **Authorized official:** SHAKIA FULLER LPCC (CEO)
- **Authorized official phone:** (706) 250-0896

## Contact information

- **Practice address:** 202 ESTELLE ST, WRENS, GA 30833-1125
- **Practice address phone:** (706) 250-0896
- **Practice address fax:** (706) 940-4761
- **Mailing address:** PO BOX 163, WRENS, GA 30833-0163
- **Mailing address phone:** (706) 250-0896
- **Mailing address fax:** (706) 940-4761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |

## Other

- **Enumeration date:** 10/14/2026
- **Last updated:** 10/14/2026