Provider Demographics
NPI:1295357028
Name:ARTIS, DESHAWN RENARDA (LPC)
Entity Type:Individual
Prefix:MR
First Name:DESHAWN
Middle Name:RENARDA
Last Name:ARTIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SHALLOWFORD RD NE APT 8220
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1243
Mailing Address - Country:US
Mailing Address - Phone:404-423-7125
Mailing Address - Fax:
Practice Address - Street 1:700 CHURCHILL CT STE 110
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6880
Practice Address - Country:US
Practice Address - Phone:770-284-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health