Provider Demographics
NPI:1922262526
Name:WOODLEY, LATESHIA SHUVONE (LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:LATESHIA
Middle Name:SHUVONE
Last Name:WOODLEY
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 1:2676 HOLLY BERRY DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3997
Mailing Address - Country:US
Mailing Address - Phone:404-399-6161
Mailing Address - Fax:404-363-4062
Practice Address - Street 1:2676 HOLLY BERRY DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3997
Practice Address - Country:US
Practice Address - Phone:404-399-6161
Practice Address - Fax:404-363-4062
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 005270101Y00000X
GA748266101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool