Individual
MARIANA BRADY SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, RPT
Contact information
Practice address
220 OAKSIDE LN, CANTON, GA 30114-6413
(678) 807-1050
Mailing address
224 WOODGLEN DR, WOODSTOCK, GA 30188-3726
(305) 812-6610
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
APC006304
GA
101YM0800X
Mental Health Counselor
Primary
LPC011898
GA
Other
Enumeration date
05/10/2018
Last updated
04/05/2023
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