Provider Demographics
NPI:1366044430
Name:STUART JOHNSON, SHELIDA (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:SHELIDA
Middle Name:
Last Name:STUART JOHNSON
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 IDLEWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6251
Mailing Address - Country:US
Mailing Address - Phone:404-935-2943
Mailing Address - Fax:
Practice Address - Street 1:4397 IDLEWOOD PARK
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-6251
Practice Address - Country:US
Practice Address - Phone:404-935-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GALPC014146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000000Other000000000
GALPC014146OtherLICENSED PROFESSIONAL COUNSELOR