Provider Demographics
NPI:1891273462
Name:CROFT, SHANDREKA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHANDREKA
Middle Name:
Last Name:CROFT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SHAN
Other - Middle Name:
Other - Last Name:CROFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:616 OAK CIR
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-2932
Mailing Address - Country:US
Mailing Address - Phone:229-699-4868
Mailing Address - Fax:
Practice Address - Street 1:20 11TH AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5650
Practice Address - Country:US
Practice Address - Phone:229-616-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001626106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist