Healthcare Provider Details

I. General information

NPI: 1841969714
Provider Name (Legal Business Name): SHELBY ANN LYNN LEVERETT LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 JENNINGS MILL RD UNIT 2200A
WATKINSVILLE GA
30677-7270
US

IV. Provider business mailing address

1551 JENNINGS MILL RD UNIT 2200A
WATKINSVILLE GA
30677-7270
US

V. Phone/Fax

Practice location:
  • Phone: 706-813-3480
  • Fax:
Mailing address:
  • Phone: 706-813-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: