Healthcare Provider Details

I. General information

NPI: 1215375209
Provider Name (Legal Business Name): SHAKEIA COWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 PARKLAKE DRIVE SUITE 350
ATLANTA GA
30345
US

IV. Provider business mailing address

2302 PARKLAKE DR NE SUITE 350
ATLANTA GA
30345-2896
US

V. Phone/Fax

Practice location:
  • Phone: 770-621-0469
  • Fax: 770-621-0466
Mailing address:
  • Phone: 770-621-0469
  • Fax: 770-621-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC50081680
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: