Provider Demographics
NPI:1285023457
Name:LAWTON, SHALETTE (LPC)
Entity Type:Individual
Prefix:
First Name:SHALETTE
Middle Name:
Last Name:LAWTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHALETTE
Other - Middle Name:
Other - Last Name:LAWTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC
Mailing Address - Street 1:150 MEDICAL WAY SUITE F1
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2533
Mailing Address - Country:US
Mailing Address - Phone:678-754-0972
Mailing Address - Fax:
Practice Address - Street 1:150 MEDICAL WAY SUITE F1
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3027
Practice Address - Country:US
Practice Address - Phone:678-754-0972
Practice Address - Fax:678-754-0972
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003780101YP2500X
GALPC0008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA814200337OtherTIN