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General NPI Number Information
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NPI Number | 1730729807
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Entity Type | Individual
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Provider Name | SHANA STYLES TRIMBLE LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 3568 HABERSHAM AT NORTHLAKE BLDG K
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City | TUCKER
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State | GA
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Zip | 30084-3008
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Country | US
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Telephone | 678-585-2300
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Fax | 678-689-0955
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Provider Business Mailing Address
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Address Line | 6287 AUSTIN PARK
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City | LITHONIA
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State | GA
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Zip | 30058-6447
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Country | US
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Telephone | 770-722-6473
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Fax | 678-689-0955
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MFT001743
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License Number State | GA
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