Provider Demographics
NPI:1821457631
Name:SHUMPERT, TATANISHA (NBCC)
Entity Type:Individual
Prefix:
First Name:TATANISHA
Middle Name:
Last Name:SHUMPERT
Suffix:
Gender:F
Credentials:NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 MAIN ST W
Mailing Address - Street 2:SUITE 20-B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3164
Mailing Address - Country:US
Mailing Address - Phone:678-344-7836
Mailing Address - Fax:678-892-8575
Practice Address - Street 1:2795 MAIN ST W
Practice Address - Street 2:SUITE 20-B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3164
Practice Address - Country:US
Practice Address - Phone:678-344-7836
Practice Address - Fax:678-892-8575
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health