Provider Demographics
NPI:1457402067
Name:MACLEOD, SHIRLEY LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LOUISE
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6485 W RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6147
Mailing Address - Country:US
Mailing Address - Phone:770-949-6105
Mailing Address - Fax:
Practice Address - Street 1:8341 GRADY ST
Practice Address - Street 2:DOUGLASVILLE, GEORGIA 30134
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6910
Practice Address - Country:US
Practice Address - Phone:678-327-8676
Practice Address - Fax:770-489-0406
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0013681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical