Provider Demographics
NPI:1770307506
Name:DALEY, SHANELL (LMSW)
Entity type:Individual
Prefix:
First Name:SHANELL
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SHADY MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5888
Mailing Address - Country:US
Mailing Address - Phone:347-633-5204
Mailing Address - Fax:
Practice Address - Street 1:1911 GRAYSON HWY STE 8187
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1245
Practice Address - Country:US
Practice Address - Phone:347-633-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker