Provider Demographics
NPI:1073954129
Name:SQUIER, SHEA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:SQUIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 JENNINGS MILL RD UNIT 1900A
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7268
Mailing Address - Country:US
Mailing Address - Phone:706-705-2571
Mailing Address - Fax:
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 1900A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7268
Practice Address - Country:US
Practice Address - Phone:706-705-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0049431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical