MEDICARE: WOODLAKE INTEGRATED SERVICES

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1720961741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAKE INTEGRATED SERVICES

Provider Business Mailing Address
First Line	:	5829 CAMPBELLTON RD SW STE 104-213
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW STE 104-213
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	470-285-1779
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHALONDRIA TURK
Credential	:	LCSW
Telephone Number	:	470-285-1779

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	09/24/2025

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