Provider Demographics
NPI:1003221144
Name:SHANDY, DUSTIN LEIGH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DUSTIN
Middle Name:LEIGH
Last Name:SHANDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:DUSTY
Other - Middle Name:
Other - Last Name:SHANDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3611 BRASELTON HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4673
Mailing Address - Country:US
Mailing Address - Phone:678-280-1390
Mailing Address - Fax:
Practice Address - Street 1:3611 BRASELTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4673
Practice Address - Country:US
Practice Address - Phone:678-280-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health