Provider Demographics
NPI:1093486086
Name:SHOOK, ADRIENNE
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:SHOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVERGROVE PKWY UNIT A4
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-7414
Mailing Address - Country:US
Mailing Address - Phone:706-410-5166
Mailing Address - Fax:
Practice Address - Street 1:1071 FOUNDERS BLVD STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6176
Practice Address - Country:US
Practice Address - Phone:770-691-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health