Provider Demographics
NPI:1568896009
Name:SHEWANOWN, MARSHA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:SHEWANOWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:LEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1260 CONCORD RD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5306
Mailing Address - Country:US
Mailing Address - Phone:770-436-2025
Mailing Address - Fax:
Practice Address - Street 1:1260 CONCORD RD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5306
Practice Address - Country:US
Practice Address - Phone:770-436-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0013901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical