Healthcare Provider Details

I. General information

NPI: 1124504766
Provider Name (Legal Business Name): SHAWN MARIE EDGINGTON LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. SHAWN MARIE HALL

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PINE VALLEY RD
SPARTA GA
31087-7187
US

IV. Provider business mailing address

1040 PINE VALLEY RD
SPARTA GA
31087-7187
US

V. Phone/Fax

Practice location:
  • Phone: 478-232-4594
  • Fax:
Mailing address:
  • Phone: 478-232-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76508
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC1215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: