Provider Demographics
NPI:1902418247
Name:SHEDRICK, SHAWNQUITA L (LAPC)
Entity Type:Individual
Prefix:
First Name:SHAWNQUITA
Middle Name:L
Last Name:SHEDRICK
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 JIMMY CARTER BLVD APT 613
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5075
Mailing Address - Country:US
Mailing Address - Phone:404-435-3875
Mailing Address - Fax:
Practice Address - Street 1:1462 MONTREAL RD STE 118
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6904
Practice Address - Country:US
Practice Address - Phone:678-580-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-05-22
Deactivation Date:2021-07-02
Deactivation Code:
Reactivation Date:2023-05-22
Provider Licenses
StateLicense IDTaxonomies
GAAPC007569101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC007569OtherLAPC - LICENSED ASSOCIATE PROFESSIONAL COUNSELOR