Healthcare Provider Details

I. General information

NPI: 1508519786
Provider Name (Legal Business Name): LASHONICA GILES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date: 06/24/2025
Reactivation Date: 09/28/2026

III. Provider practice location address

1190 W DRUID HILLS DR NE
BROOKHAVEN GA
30329-2121
US

IV. Provider business mailing address

3833 PEACHTREE RD NE APT 915
BROOKHAVEN GA
30319-5225
US

V. Phone/Fax

Practice location:
  • Phone: 404-800-9447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: