Provider Demographics
NPI:1518737063
Name:SHIPP, SHANTE L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANTE
Middle Name:L
Last Name:SHIPP
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 1:573 JACK NEELY RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-2975
Mailing Address - Country:US
Mailing Address - Phone:404-518-1516
Mailing Address - Fax:
Practice Address - Street 1:573 JACK NEELY RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-2975
Practice Address - Country:US
Practice Address - Phone:404-518-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health