Provider Demographics
NPI:1174852156
Name:DAVIS, SHA-RHONDA M (LCSW, SSW)
Entity Type:Individual
Prefix:
First Name:SHA-RHONDA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1365
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1365
Mailing Address - Country:US
Mailing Address - Phone:678-602-9709
Mailing Address - Fax:678-928-9499
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:812
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7813
Practice Address - Country:US
Practice Address - Phone:678-602-9709
Practice Address - Fax:678-928-9499
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034151041C0700X
GA6559251041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool