Individual
SHANE KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 THE EXCHANGE SE STE 100, ATLANTA, GA 30339-2022
(404) 233-3949
Mailing address
3511 ORCHARD ST, CLARKSTON, GA 30021-1145
(817) 939-3961
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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