MEDICARE: DR SHAWN THE LPC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1972378313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SHAWN THE LPC

Provider Business Mailing Address
First Line	:	930 NEW HOPE RD STE 11-652
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-6407
Country	:	US
Telephone Number	:	313-492-0000
Fax Number	:	800-554-2503

Provider Business Practice Location Address
First Line	:	105 CHANDLER RIDGE LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-6524
Country	:	US
Telephone Number	:	334-384-3331
Fax Number	:	800-554-2503

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	RICHARNE FUQUA
Credential	:	LPC
Telephone Number	:	800-554-0000

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	05/16/2026

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Directions to “DR SHAWN THE LPC ” Practice Location

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