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NPI Code Detail

MEDICARE: SHANDRA PATRICK MFT

MEDICARE: SHANDRA PATRICK MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorGA

General Provider Information

NPI Number : 1104789064
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANDRA PATRICK MFT
Provider Business Mailing Address
First Line : 1030 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2921
Country : US
Telephone Number : 404-486-9034
Fax Number :
Provider Business Practice Location Address
First Line : 1030 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2921
Country : US
Telephone Number : 404-486-9034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ SHANDRA PATRICK MFT” Practice Location

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