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General NPI Number Information
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NPI Number | 1205387487
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Entity Type | Organization
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Legal Business Name | ERIKA SHORE, PH.D., LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 1766 CENTURY BLVD NE STE B
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City | ATLANTA
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State | GA
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Zip | 30345-3394
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Country | US
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Telephone | 404-660-4010
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Fax |
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Provider Business Mailing Address
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Address Line | 1766 CENTURY BLVD NE STE B
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City | ATLANTA
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State | GA
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Zip | 30345-3394
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Country | US
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Telephone | 404-660-4010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIKA LAUREN SHORE
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Credential | PH.D.
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Telephone | 404-660-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY002788
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License Number State | GA
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