Provider Demographics
NPI:1154473627
Name:SKALIN, SHAWN R (EDS, LPC)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:R
Last Name:SKALIN
Suffix:
Gender:M
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PROFESSIONAL PARK
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117
Mailing Address - Country:US
Mailing Address - Phone:770-830-1300
Mailing Address - Fax:770-834-5469
Practice Address - Street 1:100 PROFESSIONAL PARK
Practice Address - Street 2:SUITE 302
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-830-1300
Practice Address - Fax:770-834-5469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2033OtherLICENSE NUMBER