Provider Demographics
NPI:1629225180
Name:SHOAF, EMILY MARTIN (LPC#5355)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARTIN
Last Name:SHOAF
Suffix:
Gender:F
Credentials:LPC#5355
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 WASHINGTON ST STE A2
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8567
Mailing Address - Country:US
Mailing Address - Phone:770-287-1356
Mailing Address - Fax:770-287-1352
Practice Address - Street 1:621 WASHINGTON ST STE A2
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8567
Practice Address - Country:US
Practice Address - Phone:770-287-1356
Practice Address - Fax:770-287-1352
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC#5355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional