Provider Demographics
NPI:1265073621
Name:STRACHAN, SHUNTAY RENEE (LCSW, EDD)
Entity type:Individual
Prefix:DR
First Name:SHUNTAY
Middle Name:RENEE
Last Name:STRACHAN
Suffix:
Gender:F
Credentials:LCSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 STAGLIN DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5082
Mailing Address - Country:US
Mailing Address - Phone:912-674-7002
Mailing Address - Fax:
Practice Address - Street 1:1899 LAKE RD
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2291
Practice Address - Country:US
Practice Address - Phone:404-907-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005510101YM0800X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool