Provider Demographics
NPI:1295430023
Name:ELOM, SHEDRION ZHANE (CADCII)
Entity type:Individual
Prefix:MS
First Name:SHEDRION
Middle Name:ZHANE
Last Name:ELOM
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105A BRADFORD SQ # 105-A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1900
Mailing Address - Country:US
Mailing Address - Phone:770-742-3846
Mailing Address - Fax:770-742-3855
Practice Address - Street 1:105A BRADFORD SQ # 105-A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1900
Practice Address - Country:US
Practice Address - Phone:770-742-3846
Practice Address - Fax:770-742-3855
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01672101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)