Healthcare Provider Details

I. General information

NPI: 1376122267
Provider Name (Legal Business Name): SHAQUTIA SHENA FLORENCE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ALTMORE AVE STE 200
ATLANTA GA
30342-2495
US

IV. Provider business mailing address

1200 ALTMORE AVE STE 200
ATLANTA GA
30342-2495
US

V. Phone/Fax

Practice location:
  • Phone: 678-426-2930
  • Fax: 404-256-2795
Mailing address:
  • Phone: 678-426-2930
  • Fax: 404-256-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: