Organization
SHEREKA SHAW, LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEREKA SHUNTA' SHAW LPC (LICENSED PROFESSIONAL COUNSELOR)
(404) 234-4570
Entity
Organization
Contact information
Practice address
9421 FOREST KNOLL DR, JONESBORO, GA 30238-5755
(404) 234-4570
Mailing address
9421 FOREST KNOLL DR, JONESBORO, GA 30238-5755
(404) 234-4570
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
LPC007419
GA
251S00000X
Community/Behavioral Health Agency
Primary
LPC007419
GA
252Y00000X
Early Intervention Provider Agency
LPC007419
GA
305R00000X
Preferred Provider Organization
LPC007419
GA
323P00000X
Psychiatric Residential Treatment Facility
LPC007419
GA
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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