Provider Demographics
NPI:1427343292
Name:SHEPPARD, MARY ANN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 CUMBERLAND BLVD SE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5997
Mailing Address - Country:US
Mailing Address - Phone:210-323-1892
Mailing Address - Fax:
Practice Address - Street 1:44 DARBYS CROSSING DR
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-6008
Practice Address - Country:US
Practice Address - Phone:678-638-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64376101YP2500X
GALPC008805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional