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General NPI Number Information
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NPI Number | 1972378313
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Entity Type | Organization
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Legal Business Name | DR SHAWN THE LPC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 05/16/2026
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Provider Practice Location Address
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Address Line | 105 CHANDLER RIDGE LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6524
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Country | US
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Telephone | 334-384-3331
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Fax | 800-554-2503
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Provider Business Mailing Address
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Address Line | 930 NEW HOPE RD STE 11-652
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-6407
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Country | US
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Telephone | 313-492-0000
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Fax | 800-554-2503
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | RICHARNE FUQUA
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Credential | LPC
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Telephone | 800-554-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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