Provider Demographics
NPI:1295807550
Name:REED, SHELLEY WILLETTS (CAC II, SAM)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:WILLETTS
Last Name:REED
Suffix:
Gender:F
Credentials:CAC II, SAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 STEVE MAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4421
Mailing Address - Country:US
Mailing Address - Phone:706-596-5523
Mailing Address - Fax:706-596-5539
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-596-5523
Practice Address - Fax:706-596-5539
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1851101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)