Provider Demographics
NPI:1407282536
Name:HARRIS, SHAKEDRA LITTLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAKEDRA
Middle Name:LITTLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 GA HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-9307
Mailing Address - Country:US
Mailing Address - Phone:229-938-9573
Mailing Address - Fax:
Practice Address - Street 1:546 GA HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-9307
Practice Address - Country:US
Practice Address - Phone:229-938-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GACSW0059791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor