Healthcare Provider Details

I. General information

NPI: 1225684517
Provider Name (Legal Business Name): SHANIA MONIQUE DEWBERRY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 HOSPITAL RD
NEWNAN GA
30263-1209
US

IV. Provider business mailing address

22 BELMONT PARK DR
NEWNAN GA
30263-1388
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-4610
  • Fax:
Mailing address:
  • Phone: 229-379-1294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: