Provider Demographics
NPI:1760981195
Name:MIXON, SHAMEIA NICOLE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SHAMEIA
Middle Name:NICOLE
Last Name:MIXON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:SHAMEIA
Other - Middle Name:NICOLE
Other - Last Name:PASCHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAPC, NCC
Mailing Address - Street 1:5436 RIVERDALE RD STE 125C
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6938
Mailing Address - Country:US
Mailing Address - Phone:470-240-1556
Mailing Address - Fax:
Practice Address - Street 1:6251 BALTUSROL TRCE
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5126
Practice Address - Country:US
Practice Address - Phone:404-936-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006288101YP2500X
GALPC012231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional