Provider Demographics
NPI:1639784861
Name:SHOULDERS, YVETTE ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:ELIZABETH
Last Name:SHOULDERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 GREAT MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2799
Mailing Address - Country:US
Mailing Address - Phone:347-717-1778
Mailing Address - Fax:
Practice Address - Street 1:733 SECOND AVENUE
Practice Address - Street 2:FRANK R. FERGUSON BUILDING
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK153656104100000X
GAMSW008794104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker