Provider Demographics
NPI:1003683814
Name:SILAS, SHURNIKA BREANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:SHURNIKA
Middle Name:BREANNA
Last Name:SILAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BOWLES ST SW
Mailing Address - Street 2:
Mailing Address - City:BACONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31716-7651
Mailing Address - Country:US
Mailing Address - Phone:122-934-4458
Mailing Address - Fax:
Practice Address - Street 1:226 BOWLES ST SW
Practice Address - Street 2:
Practice Address - City:BACONTON
Practice Address - State:GA
Practice Address - Zip Code:31716-7651
Practice Address - Country:US
Practice Address - Phone:229-344-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker