Healthcare Provider Details

I. General information

NPI: 1245358852
Provider Name (Legal Business Name): JEANIE WITCRAFT SHIAU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 HAYNES BRIDGE RD STE 200
JOHNS CREEK GA
30022-1913
US

IV. Provider business mailing address

12095 CRABAPPLE LAKE DR
ROSWELL GA
30076-4260
US

V. Phone/Fax

Practice location:
  • Phone: 678-667-1673
  • Fax:
Mailing address:
  • Phone: 678-809-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW4650
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTLS1180CP
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW4647
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: