| Doctor Name: | MRS. SHELLY WONG CORDSEN |
| NPI Number: | 1023334984 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC005306 |
| Business Practice Address: | 11 Lumpkin St Ste 100 Lawrenceville, GA - 300468451 |
| Business Phone Number: | 6784040112 |
| Business Fax Number: | |
| Mailing Address: | Po Box 454, SUWANEE |
| State: | GA |
| Postal Code: | 300240454 |
| Phone Number: | 6784040112 |
| Fax Number: | |
| NPI Enumeration Date: | 04/15/2010 |
| NPI Last Update Date: | 04/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC005306 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |