Provider Demographics
NPI:1316534613
Name:HARKINS, SHAWNA (CADC1)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HARKINS
Suffix:
Gender:F
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-8913
Mailing Address - Country:US
Mailing Address - Phone:706-781-6987
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8913
Practice Address - Country:US
Practice Address - Phone:706-781-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1316186968Medicaid