Provider Demographics
NPI:1114730637
Name:WARREN, SHALON MONIQUE (MSW CPS-P)
Entity type:Individual
Prefix:
First Name:SHALON
Middle Name:MONIQUE
Last Name:WARREN
Suffix:
Gender:F
Credentials:MSW CPS-P
Other - Prefix:
Other - First Name:SHALON
Other - Middle Name:MONIQUE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, CPS-P
Mailing Address - Street 1:3064 KINGS GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6794
Mailing Address - Country:US
Mailing Address - Phone:404-641-0278
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE STE 707
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5510
Practice Address - Country:US
Practice Address - Phone:404-641-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty