Provider Demographics
NPI:1831963545
Name:LOUDERMILK, SHANE MAREE' (MS, NCC, APC)
Entity type:Individual
Prefix:MRS
First Name:SHANE
Middle Name:MAREE'
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:MS, NCC, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ATLANTA STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:470-781-4455
Mailing Address - Fax:
Practice Address - Street 1:97 ATLANTA ST
Practice Address - Street 2:STE 301
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:470-781-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional