Provider Demographics
NPI:1821197823
Name:SHUFORD, JANICE R (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:R
Last Name:SHUFORD
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 1:1684 DURRETT WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2912
Mailing Address - Country:US
Mailing Address - Phone:770-908-3993
Mailing Address - Fax:770-730-8721
Practice Address - Street 1:211 PERIMETER CENTER PKWY NE STE 910
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30346-1304
Practice Address - Country:US
Practice Address - Phone:770-908-3993
Practice Address - Fax:770-730-8721
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2597101YM0800X, 1041C0700X
GACSW002597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist