Provider Demographics
NPI:1942432885
Name:UPSHAW, WAIKIKI L (EDD, NCC, LPC)
Entity Type:Individual
Prefix:DR
First Name:WAIKIKI
Middle Name:L
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:EDD, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BROOKSTONE CRST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2270
Mailing Address - Country:US
Mailing Address - Phone:770-356-6145
Mailing Address - Fax:770-251-1713
Practice Address - Street 1:286 HIGHWAY 138 SW
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4010
Practice Address - Country:US
Practice Address - Phone:770-629-4833
Practice Address - Fax:770-703-6687
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional