Provider Demographics
NPI:1215473624
Name:WARE, SHAKAYLA (LPC)
Entity type:Individual
Prefix:
First Name:SHAKAYLA
Middle Name:
Last Name:WARE
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 1:337 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5418
Mailing Address - Country:US
Mailing Address - Phone:912-452-2352
Mailing Address - Fax:912-225-3454
Practice Address - Street 1:337 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5418
Practice Address - Country:US
Practice Address - Phone:912-452-2352
Practice Address - Fax:912-225-3454
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009193251S00000X, 101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor