Provider Demographics
NPI:1457130700
Name:SHINE-CROSS, SHERICE NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:SHERICE
Middle Name:NICOLE
Last Name:SHINE-CROSS
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 1:2575 TRILLIUM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1471
Mailing Address - Country:US
Mailing Address - Phone:843-819-4111
Mailing Address - Fax:
Practice Address - Street 1:2575 TRILLIUM VIEW DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1471
Practice Address - Country:US
Practice Address - Phone:843-819-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty