Provider Demographics
NPI:1093416117
Name:JALLAH, TUJUANA SHAW (LPC)
Entity Type:Individual
Prefix:
First Name:TUJUANA
Middle Name:SHAW
Last Name:JALLAH
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 1:11605 ABERCORN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1903
Mailing Address - Country:US
Mailing Address - Phone:912-412-1275
Mailing Address - Fax:912-257-7282
Practice Address - Street 1:1698 STILLWOOD DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2513
Practice Address - Country:US
Practice Address - Phone:912-412-1275
Practice Address - Fax:912-257-7282
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty