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General NPI Number Information
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NPI Number | 1316449572
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Entity Type | Individual
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Provider Name | SHAMARA MOODY LPC, DCC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 245 COUNTRY CLUB DR BLDG 100D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7216
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Country | US
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Telephone | 404-408-7483
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Fax |
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Provider Business Mailing Address
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Address Line | 250 GEORGIA AVE E UNIT 1854
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-5519
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Country | US
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Telephone | 404-408-7483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC009502
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License Number State | GA
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