Healthcare Provider Details

I. General information

NPI: 1083667125
Provider Name (Legal Business Name): SHAWNA MARIE HARLIN-CLIFTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 W MAIN ST
SWAINSBORO GA
30401-3163
US

IV. Provider business mailing address

PO BOX 1094
SWAINSBORO GA
30401-1094
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-2484
  • Fax: 478-237-7541
Mailing address:
  • Phone: 478-237-2484
  • Fax: 478-237-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 003758
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: