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NPI Code Detail

MEDICARE: MS. SHASHONDALYN SHANAY SAMUELS CM

MEDICARE: MS. SHASHONDALYN SHANAY SAMUELS CM
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
1101YP2500XProfessional CounselorLPC016534GA

General Provider Information

NPI Number : 1528628104
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHASHONDALYN SHANAY SAMUELS CM
Provider Business Mailing Address
First Line : 2400 HONEY CT
Second Line :
City : MCDONOUGH
State : GA
Zip : 30252-8503
Country : US
Telephone Number : 470-923-0252
Fax Number :
Provider Business Practice Location Address
First Line : 1944 BRANNAN RD
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-4310
Country : US
Telephone Number : 678-289-6981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2019
Last Update Date : 03/16/2026

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