Provider Demographics
NPI:1497923650
Name:SHEA, TIMOTHY MICHAEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:SHEA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 MORELAND AVE NE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1582
Mailing Address - Country:US
Mailing Address - Phone:678-571-6798
Mailing Address - Fax:
Practice Address - Street 1:449 MORELAND AVE NE
Practice Address - Street 2:SUITE 205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1582
Practice Address - Country:US
Practice Address - Phone:678-571-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional