MRS. KATHLEEN SHACK (NPI# 1164567137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164567137 |
| Entity Type | Individual |
| Full Name | MRS. KATHLEEN SHACK |
| Credential | M.S., LMFT |
| Practice Address |
290 Constitution Blvd Suite D Lawrenceville GA 30045-5638 |
| Mailing Address |
5825 Millwick Dr Alpharetta GA 30005-6732 |
| Practice Telephone | 6782200090 |
| Mailing Telephone | 6787702200 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 0000928 | GA | Behavioral Health & Social Service Providers |
| Street Address |
290 CONSTITUTION BLVD SUITE D |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30045-5638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609870179 | Mark E James | Psychiatry & Neurology | 290 Constitution Blvd, Ste A, Lawrenceville, GA 30046-5696 | 2005-06-13 |
| 1851694590 | Lifeskills Counseling Services | Community/Behavioral Health | 290 Constitution Blvd, D, Lawrenceville, GA 30046-5696 | 2010-12-20 |
| 1740325125 | David William Kuglin | Counselor | 290 Constitution Blvd, D, Lawrenceville, GA 30046-5696 | 2007-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285104315 | Shalanda Monique Booker | Counselor | 2940 Emerald Springs Drive, Lawrenceville, GA 30045 | 2018-12-02 |
| 1669957320 | Chantelle S Fuller | Behavioral Analyst | 805 Donington Cir, Lawrenceville, GA 30045 | 2018-09-28 |
| 1356836035 | Gad Health Care LLC | Home Health | 1140 Great Oaks Dr, Lawrenceville, GA 30045 | 2018-06-26 |
| 1346668662 | Eca Optical, LLC | Eyewear Supplier (Equipment, not the service) | 601-a Professional Drive, Ste 170, Lawrenceville, GA 30045 | 2014-04-03 |
| 1598102733 | Selena Fuller | Nurse Practitioner | 181 South Clayton Street, Lawrenceville, GA 30045 | 2013-05-29 |
| 1942555982 | Vida Michele James-bryant | Community Health Worker | 1309 Avington Glen Dr, Lawrenceville, GA 30045 | 2012-07-16 |
| 1770840639 | Rebecca Vinson D'angelo | Occupational Therapist | 1518 Great Shoals Cir, Lawrenceville, GA 30045 | 2012-04-17 |
| 1427346774 | Amanda Michelel Woods | Psychologist | 285 South Perry Street, Lawrenceville, GA 30045 | 2011-07-20 |
| 1790070563 | M & G Pharmacy Inc | Pharmacy | 100 Hurricane Shoals Rd Suite F, Lawrenceville, GA 30045 | 2011-06-09 |
| 1306146154 | Thanh Dau | Optometrist | 1250 Scenic Highway, Ste 1268, Lawrenceville, GA 30045 | 2010-10-27 |
| Find all providers in zip 30045 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295283398 | Shontel Cargill | Marriage & Family Therapist | 3146 Cleftstone Trl, Lawrenceville, GA 30046-9404 | 2016-09-17 |
| 1497153019 | Rachael Chisholm | Marriage & Family Therapist | 1736 Sever Rd, Lawrenceville, GA 30043-4111 | 2014-12-12 |
| 1700126869 | Nonah Marie Elliston | Marriage & Family Therapist | 1014 Veranda Chase Dr, Lawrenceville, GA 30044-7178 | 2013-02-26 |
| 1700158912 | Diane C. Dierks, Lmft, LLC | Marriage & Family Therapist | 413 Constitution Blvd., Suite D, Lawrenceville, GA 30046-4736 | 2012-02-02 |
| 1013159151 | Diane Chambers Dierks | Marriage & Family Therapist | 400 W Crogan St, Suite D, Lawrenceville, GA 30046-4736 | 2009-04-06 |
| 1407027188 | Sharon Belhamel | Marriage & Family Therapist | 1011 Simon Park Cir, Lawrenceville, GA 30045-8532 | 2008-03-20 |
| 1013128594 | Bernard Michael Hodgdon | Marriage & Family Therapist | 29 Karena Ln, Lawrenceville, NJ 08648-2813 | 2007-05-25 |
| 1336704022 | Michael Ramsey | Marriage & Family Therapist | 175 Gwinnett Dr, Lawrenceville, GA 30046-8444 | 2019-05-08 |
| 1578007365 | Jennifer Terina Mejias | Marriage & Family Therapist | 965 Oakland Rd, Suite 3b, Lawrenceville, GA 30044-3758 | 2016-12-13 |
| 1871992032 | Nakita Robinson | Marriage & Family Therapist | 175 Gwinnett Dr, Lawrenceville, GA 30046-8444 | 2014-08-13 |
| Find all providers in LAWRENCEVILLE | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30045 |
Please comment or provide details below to improve the information on MRS. KATHLEEN SHACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.