Provider Demographics
NPI:1154691087
Name:JENSEN, SHONDALEA M (LAPC)
Entity type:Individual
Prefix:
First Name:SHONDALEA
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-9000
Mailing Address - Country:US
Mailing Address - Phone:770-836-6678
Mailing Address - Fax:770-830-2266
Practice Address - Street 1:153 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-9000
Practice Address - Country:US
Practice Address - Phone:770-836-6678
Practice Address - Fax:770-830-2266
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002685101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor