Provider Demographics
NPI:1407350945
Name:SHEPPARD, KATHERINE LENAI (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LENAI
Last Name:SHEPPARD
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 1:7340 THOREAU CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1063
Mailing Address - Country:US
Mailing Address - Phone:760-617-0300
Mailing Address - Fax:
Practice Address - Street 1:7340 THOREAU CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1063
Practice Address - Country:US
Practice Address - Phone:760-617-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-1256707OtherIRS DEPARTMENT OF THE TREASURY INTERNAL REVEUE SERVICE