Provider Demographics
NPI:1619627031
Name:SHELTON, LEONARD CHARLES (LPC, CVE, CRC)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:CHARLES
Last Name:SHELTON
Suffix:
Gender:M
Credentials:LPC, CVE, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 ASHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7709
Mailing Address - Country:US
Mailing Address - Phone:404-940-3490
Mailing Address - Fax:
Practice Address - Street 1:127 S COURT SQ
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-0401
Practice Address - Country:US
Practice Address - Phone:334-655-4522
Practice Address - Fax:334-460-0899
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ALALC04053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health