Provider Demographics
NPI:1013502624
Name:SHRINER, TEDRA DOROTHY LUCILLE (EDS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TEDRA
Middle Name:DOROTHY LUCILLE
Last Name:SHRINER
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:TEDDI
Other - Middle Name:DOROTHY LUCILLE
Other - Last Name:SHRINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS, LPC
Mailing Address - Street 1:101 SOUTHCREEK PL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2334
Mailing Address - Country:US
Mailing Address - Phone:706-766-5794
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTHCREEK PL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2334
Practice Address - Country:US
Practice Address - Phone:706-766-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA767889101YS0200X
GA011444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool