Provider Demographics
NPI:1124221585
Name:KEITH, SHARANDA (LPC, CPCS)
Entity Type:Individual
Prefix:MS
First Name:SHARANDA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MICAH CT
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8509
Mailing Address - Country:US
Mailing Address - Phone:678-675-2272
Mailing Address - Fax:
Practice Address - Street 1:404 MICAH CT
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8509
Practice Address - Country:US
Practice Address - Phone:678-378-2741
Practice Address - Fax:470-729-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GALPC006881101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health