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Individual

SHELLEY NORTHRUP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC, ED.S, MH.S

Contact information

Practice address
11138 STATE BRIDGE RD STE 100A, ALPHARETTA, GA 30022-7465
(678) 274-4936
Mailing address
11138 STATE BRIDGE ROAD, SUITE 100A, ATLANTA, GA 30337-3605
(678) 274-4936

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
APC005359
GA
101YM0800X
Mental Health Counselor
Primary
LPC010477
GA

Other

Enumeration date
04/19/2016
Last updated
02/21/2019
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