Provider Demographics
NPI:1114270436
Name:SHIELDS, PARIS C (LCSW)
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:C
Last Name:SHIELDS
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 1:2704 N OAK ST BLDG J
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1768
Mailing Address - Country:US
Mailing Address - Phone:229-262-7333
Mailing Address - Fax:229-262-7335
Practice Address - Street 1:100 N PATTERSON ST # 94
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5570
Practice Address - Country:US
Practice Address - Phone:229-300-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005835104100000X
GACSW0056761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW005676OtherGEORGIA COMPOSITE BOARD OF PC, SW AND LMFT