Healthcare Provider Details

I. General information

NPI: 1619627031
Provider Name (Legal Business Name): LEONARD CHARLES SHELTON LPC, CVE, CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S COURT SQ
OZARK AL
36360-0401
US

IV. Provider business mailing address

4170 ASHLAND CIR
DOUGLASVILLE GA
30135-7709
US

V. Phone/Fax

Practice location:
  • Phone: 334-655-4522
  • Fax: 334-460-0899
Mailing address:
  • Phone: 334-200-9261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05057
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: