Provider Demographics
NPI:1407098668
Name:ALEXANDER, SHAWN (LPC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 441 HISTORIC HWY N
Mailing Address - Street 2:SUITE E-4
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4144
Mailing Address - Country:US
Mailing Address - Phone:706-768-0010
Mailing Address - Fax:
Practice Address - Street 1:1070 441 HISTORIC HWY N
Practice Address - Street 2:SUITE E-4
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4144
Practice Address - Country:US
Practice Address - Phone:706-768-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional