Provider Demographics
NPI:1912656885
Name:GARDNER SPATES, SHARIKA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARIKA
Middle Name:D
Last Name:GARDNER SPATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 OKEFENOKEE RDG
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3382
Mailing Address - Country:US
Mailing Address - Phone:404-216-2808
Mailing Address - Fax:
Practice Address - Street 1:3753 OKEFENOKEE RDG
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3382
Practice Address - Country:US
Practice Address - Phone:404-216-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0078251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical