Provider Demographics
NPI:1740946631
Name:CAMPBELL, SHANA N (LPC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:N
Last Name:CAMPBELL
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 1:755 COMMERCE DR STE 720
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2621
Mailing Address - Country:US
Mailing Address - Phone:678-855-8173
Mailing Address - Fax:404-393-9104
Practice Address - Street 1:755 COMMERCE DR STE 720
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2621
Practice Address - Country:US
Practice Address - Phone:678-855-8173
Practice Address - Fax:404-393-9104
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007972101YM0800X
GALPC014233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health