Provider Demographics
NPI:1376116954
Name:NOURSE, SHYANNE ATOCHA
Entity type:Individual
Prefix:
First Name:SHYANNE
Middle Name:ATOCHA
Last Name:NOURSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHYANNE
Other - Middle Name:ATOCHA
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAP, CADC, CADC-II
Mailing Address - Street 1:201 PILOT ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-1123
Mailing Address - Country:US
Mailing Address - Phone:505-917-3844
Mailing Address - Fax:
Practice Address - Street 1:302 RICE HOPE PLANTATION RD
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-9653
Practice Address - Country:US
Practice Address - Phone:912-414-7054
Practice Address - Fax:866-414-7054
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01875OtherCADC-II
FLCAP.0100620OtherCAP
FLICADC.0000273OtherICADC