Provider Demographics
NPI:1609534312
Name:SHOEMAKER, KIRSTEN TAMARA (BSW)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:TAMARA
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW
Mailing Address - Street 1:419 FULLERS CHAPEL RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-7452
Mailing Address - Country:US
Mailing Address - Phone:706-508-5707
Mailing Address - Fax:
Practice Address - Street 1:1289 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2069
Practice Address - Country:US
Practice Address - Phone:706-971-3366
Practice Address - Fax:706-426-0949
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical