Healthcare Provider Details

I. General information

NPI: 1730414939
Provider Name (Legal Business Name): SHARRON LASHAWN CROSS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 540
BROOKHAVEN GA
30329
US

IV. Provider business mailing address

PO BOX 495
AVONDALE EST GA
30002-0495
US

V. Phone/Fax

Practice location:
  • Phone: 404-907-0431
  • Fax:
Mailing address:
  • Phone: 404-704-2653
  • Fax: 404-745-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC006271
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006271
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: