Provider Demographics
NPI:1396062295
Name:SHOEMAKER, KRISTEN E (MAED, LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:E
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MAED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DEWPOINT LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7144
Mailing Address - Country:US
Mailing Address - Phone:843-412-0776
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR STE L3
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5630
Practice Address - Country:US
Practice Address - Phone:404-369-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-01
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5403101YM0800X
GA012646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1124831318OtherNPESS