Provider Demographics
NPI:1073204376
Name:DEADY, SHELLEY RENEE (LAMFT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:DEADY
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RICHMOND GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8216
Mailing Address - Country:US
Mailing Address - Phone:858-943-9334
Mailing Address - Fax:
Practice Address - Street 1:1755 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2135
Practice Address - Country:US
Practice Address - Phone:470-588-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist