Provider Demographics
NPI:1407520034
Name:SHEPHERD, DENISE LASHAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LASHAN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:DENIE
Other - Middle Name:LASHAN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:73 NORTHWYNN DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2197
Mailing Address - Country:US
Mailing Address - Phone:678-416-1307
Mailing Address - Fax:
Practice Address - Street 1:73 NORTHWYNN DR
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2197
Practice Address - Country:US
Practice Address - Phone:678-416-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC004597OtherLICENSE