Provider Demographics
NPI:1912223934
Name:VAID, SHALLY (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHALLY
Middle Name:
Last Name:VAID
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BIRMINGHAM RD STE 501-385
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4417
Mailing Address - Country:US
Mailing Address - Phone:678-209-1732
Mailing Address - Fax:
Practice Address - Street 1:20116 ASHBROOK PL STE 110120
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5086
Practice Address - Country:US
Practice Address - Phone:571-977-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2023-04-25
Deactivation Date:2023-02-23
Deactivation Code:
Reactivation Date:2023-04-25
Provider Licenses
StateLicense IDTaxonomies
GALPC006531101YP2500X
VA0701011923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional