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General NPI Number Information
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NPI Number | 1831252220
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Entity Type | Individual
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Provider Name | RICHARD E SHOOK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 800 KENNESAW AVE NW STE 320
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City | MARIETTA
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State | GA
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Zip | 30060-7945
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Country | US
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Telephone | 770-514-0111
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Fax | 404-592-4648
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Provider Business Mailing Address
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Address Line | 2001 DUNCAN DR NW UNIT 2714
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City | KENNESAW
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State | GA
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Zip | 30156-0465
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Country | US
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Telephone | 770-514-0111
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Fax | 404-592-4648
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1908
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License Number State | GA
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