=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669645198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUIANA SHE'REE SYDNOR LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2008
-----------------------------------------------------
Last Update Date | 11/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 GWINNETT DR
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30045-8444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-339-5377
-----------------------------------------------------
Fax | 770-339-5016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1435 BOGGS RD #2322
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30096-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-784-0076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC006606
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------