Provider Demographics
NPI:1114393287
Name:KIRKSEY, SHELIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHELIA
Middle Name:
Last Name:KIRKSEY
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 1:1231 BLAIRS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5942
Mailing Address - Country:US
Mailing Address - Phone:402-871-7488
Mailing Address - Fax:
Practice Address - Street 1:1201 CLAIRMONT RD
Practice Address - Street 2:SUITE 110, OFFICE #2
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1258
Practice Address - Country:US
Practice Address - Phone:678-871-7028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical