Individual
JEREMY DANIEL SHAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
101 MYRTLE ST, CARROLLTON, GA 30117-2212
(404) 512-4030
Mailing address
101 MYRTLE ST, CARROLLTON, GA 30117-2212
(404) 512-4030
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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