Provider Demographics
NPI:1073381034
Name:CLARKE, SHAWNTA DIONE (LPC)
Entity Type:Individual
Prefix:
First Name:SHAWNTA
Middle Name:DIONE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SAINT MARLO CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7413
Mailing Address - Country:US
Mailing Address - Phone:678-372-4759
Mailing Address - Fax:
Practice Address - Street 1:1801 SAINT MARLO CT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-7413
Practice Address - Country:US
Practice Address - Phone:678-372-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional