Provider Demographics
NPI:1154897296
Name:HARPER, SHONTA (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHONTA
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 OSBORNE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-8497
Mailing Address - Country:US
Mailing Address - Phone:912-882-7383
Mailing Address - Fax:855-793-1274
Practice Address - Street 1:708 OSBORNE ST STE 104
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:229-591-4772
Practice Address - Fax:855-793-1274
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty