Provider Demographics
NPI:1710427885
Name:COOLEY, SHAMIKA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:DIANE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ALCOVY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2180
Mailing Address - Country:US
Mailing Address - Phone:229-630-9656
Mailing Address - Fax:
Practice Address - Street 1:333 ALCOVY ST STE 6
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:229-630-9656
Practice Address - Fax:678-635-7152
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical