Provider Demographics
NPI:1316672108
Name:BILLINGS, SHANISE DELIVEYON (LCSW)
Entity type:Individual
Prefix:
First Name:SHANISE
Middle Name:DELIVEYON
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 FLOWING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2737
Mailing Address - Country:US
Mailing Address - Phone:478-394-2328
Mailing Address - Fax:
Practice Address - Street 1:234 FLOWING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2737
Practice Address - Country:US
Practice Address - Phone:478-394-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0079191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty