Doctor Name: | MRS. SHANEKA L MCCLARTY |
NPI Number: | 1124356738 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 005789 |
Business Practice Address: | 1825 Morning Star Ln Tucker, GA - 300847150 |
Business Phone Number: | 4044210069 |
Business Fax Number: | 4045926425 |
Mailing Address: | 1825 Morning Star Ln, TUCKER |
State: | GA |
Postal Code: | 300847150 |
Phone Number: | 4044210069 |
Fax Number: | 4045926425 |
NPI Enumeration Date: | 11/20/2009 |
NPI Last Update Date: | 08/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 005789 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |