Individual
MISS SHAWNA-GAYE FAGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC
Contact information
Practice address
270 CARPENTER DR, SUITE 400, ATLANTA, GA 30328-4931
(678) 460-0345
Mailing address
119 SHADOWHILL LN, LOGANVILLE, GA 30052-8289
(404) 825-9705
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC009436
GA
Other
Enumeration date
04/12/2017
Last updated
04/12/2017
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