Provider Demographics
NPI:1134267859
Name:SHEWELL, JUSTIN MATTHEW (MS, MSW, PSYD LCSW)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MATTHEW
Last Name:SHEWELL
Suffix:
Gender:M
Credentials:MS, MSW, PSYD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 S MILLEDGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5661
Mailing Address - Country:US
Mailing Address - Phone:706-424-5888
Mailing Address - Fax:678-302-0196
Practice Address - Street 1:188 S MILLEDGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-5661
Practice Address - Country:US
Practice Address - Phone:706-424-5888
Practice Address - Fax:678-302-0196
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COLCSW5701041C0700X
FLSW 72071041C0700X
GAPSY003451103T00000X
GACSW0038601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical