Provider Demographics
NPI:1619363884
Name:SHEREKA SHAW, LPC
Entity Type:Organization
Organization Name:SHEREKA SHAW, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEREKA
Authorized Official - Middle Name:SHUNTA'
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-234-4570
Mailing Address - Street 1:9421 FOREST KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5755
Mailing Address - Country:US
Mailing Address - Phone:404-234-4570
Mailing Address - Fax:
Practice Address - Street 1:9421 FOREST KNOLL DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-5755
Practice Address - Country:US
Practice Address - Phone:404-234-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007419251B00000X, 251S00000X, 252Y00000X, 305R00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility