Provider Demographics
NPI:1609220326
Name:NORTHRUP, SHELLEY (LPC, EDS, MHS)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:LPC, EDS, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11138 STATE BRIDGE ROAD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-3605
Mailing Address - Country:US
Mailing Address - Phone:678-274-4936
Mailing Address - Fax:
Practice Address - Street 1:11138 STATE BRIDGE RD STE 100A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7465
Practice Address - Country:US
Practice Address - Phone:678-274-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005359101YM0800X
GALPC010477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health