Provider Demographics
NPI:1912096520
Name:SHAMS, YOUSEF (MS LPC)
Entity Type:Individual
Prefix:
First Name:YOUSEF
Middle Name:
Last Name:SHAMS
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 MACY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6339
Mailing Address - Country:US
Mailing Address - Phone:678-795-0346
Mailing Address - Fax:678-795-9709
Practice Address - Street 1:1902 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6339
Practice Address - Country:US
Practice Address - Phone:678-795-0346
Practice Address - Fax:678-795-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0909101YA0400X, 106H00000X
GA00909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPEACH STATE HEALTH/CMedicaid
GAPEACHCARE FOR KIDSMedicaid
GAWELL CARE OF GEORGIAMedicaid
AETNA HEALTH CAREOther0007106410
BLUE CROSS/BLUE SHEIOther52889675
GAPEACH CARE FOR KIDSMedicaid
VALUE OPTIONOther513726