Provider Demographics
NPI:1831355254
Name:SHINNICK, PATRICK JAMES (LCSW, ACSW, NCAC 1)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:SHINNICK
Suffix:
Gender:M
Credentials:LCSW, ACSW, NCAC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 OAK GREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8703
Mailing Address - Country:US
Mailing Address - Phone:678-377-0033
Mailing Address - Fax:
Practice Address - Street 1:142 OAK GREEN DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8703
Practice Address - Country:US
Practice Address - Phone:678-377-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0026391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical